Provider Demographics
NPI:1730487125
Name:LITTLE FALLS MEDCARE
Entity Type:Organization
Organization Name:LITTLE FALLS MEDCARE
Other - Org Name:LITTLE FALLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH. IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:POLISE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:702-561-5628
Mailing Address - Street 1:75 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1107
Mailing Address - Country:US
Mailing Address - Phone:973-638-1561
Mailing Address - Fax:973-638-1566
Practice Address - Street 1:75 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1107
Practice Address - Country:US
Practice Address - Phone:973-638-1561
Practice Address - Fax:973-638-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00711000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00711000OtherPHARMACY LICENSE NUMBER