Provider Demographics
NPI:1073843926
Name:PROGRESSIVE PHARMACY LLC
Entity Type:Organization
Organization Name:PROGRESSIVE PHARMACY LLC
Other - Org Name:PROGRESSIVE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:ROCCO
Authorized Official - Last Name:GIANCARLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-825-0660
Mailing Address - Street 1:85 HARRETON RD
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1317
Mailing Address - Country:US
Mailing Address - Phone:201-785-0200
Mailing Address - Fax:201-785-0208
Practice Address - Street 1:85 HARRETON RD
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1317
Practice Address - Country:US
Practice Address - Phone:201-785-0200
Practice Address - Fax:201-785-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007000003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy