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NPI Code Detail

MEDICARE: PROGRESSIVE PHARMACY LLC

MEDICARE: PROGRESSIVE PHARMACY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336L0003XLong Term Care Pharmacy28RS00700000NJ

General Provider Information

NPI Number : 1073843926
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESSIVE PHARMACY LLC
Provider Business Mailing Address
First Line : 85 HARRETON RD
Second Line :
City : ALLENDALE
State : NJ
Zip : 07401-1317
Country : US
Telephone Number : 201-785-0200
Fax Number : 201-785-0208
Provider Business Practice Location Address
First Line : 85 HARRETON RD
Second Line :
City : ALLENDALE
State : NJ
Zip : 07401-1317
Country : US
Telephone Number : 201-785-0200
Fax Number : 201-785-0208
Authorized Official
Title or Position : OWNER
Name : DR. HECTOR ROCCO GIANCARLO
Credential : MD
Telephone Number : 201-825-0660
Provider Enumeration Date : 12/28/2009
Last Update Date : 12/28/2009

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Directions to “PROGRESSIVE PHARMACY LLC ” Practice Location

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