Provider Demographics
NPI:1073007340
Name:OUTPATIENT PHARMACY CORP
Entity Type:Organization
Organization Name:OUTPATIENT PHARMACY CORP
Other - Org Name:INVICTUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEYER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:201-880-7000
Mailing Address - Street 1:120 E 56TH ST RM 900
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3644
Mailing Address - Country:US
Mailing Address - Phone:212-380-6866
Mailing Address - Fax:201-991-1980
Practice Address - Street 1:60 ESSEX ST STE 202
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4347
Practice Address - Country:US
Practice Address - Phone:201-991-0800
Practice Address - Fax:201-991-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ333600000X
3336M0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy