Provider Demographics
NPI:1538100441
Name:MORRIS PLAINS PHARMACY, LLC
Entity Type:Organization
Organization Name:MORRIS PLAINS PHARMACY, LLC
Other - Org Name:MORRIS PLAINS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAJINEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-539-3635
Mailing Address - Street 1:712 SPEEDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2269
Mailing Address - Country:US
Mailing Address - Phone:973-539-3635
Mailing Address - Fax:973-539-8447
Practice Address - Street 1:712 SPEEDWELL AVE
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2269
Practice Address - Country:US
Practice Address - Phone:973-539-3635
Practice Address - Fax:973-539-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00399600333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133079OtherPK
NJ6693500001Medicare NSC