Provider Demographics
NPI:1164744546
Name:MPS RX TRI-STATE LLC
Entity Type:Organization
Organization Name:MPS RX TRI-STATE LLC
Other - Org Name:MILLENNIUM PHARMACY SYSTEMS INC S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, BUSINESS SYSTEMS SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DELANY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-784-1643
Mailing Address - Street 1:22 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-2600
Mailing Address - Country:US
Mailing Address - Phone:201-784-1643
Mailing Address - Fax:
Practice Address - Street 1:22 PARIS AVE
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-2600
Practice Address - Country:US
Practice Address - Phone:201-784-1643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00701000332B00000X, 333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherMEDICARE & MEDICAID PENDING