Provider Demographics
NPI:1972641009
Name:MPRL PHARMACY, INC
Entity Type:Organization
Organization Name:MPRL PHARMACY, INC
Other - Org Name:ABELS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-373-6038
Mailing Address - Street 1:635 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3719
Mailing Address - Country:US
Mailing Address - Phone:973-373-6038
Mailing Address - Fax:973-399-4466
Practice Address - Street 1:635 GROVE ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3719
Practice Address - Country:US
Practice Address - Phone:973-373-6038
Practice Address - Fax:973-399-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS004187003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4399200Medicaid
NJ4399200Medicaid