Provider Demographics
NPI:1932254836
Name:INVESTRA CORP
Entity Type:Organization
Organization Name:INVESTRA CORP
Other - Org Name:LISS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DELROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-277-0399
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07902-0638
Mailing Address - Country:US
Mailing Address - Phone:908-277-0399
Mailing Address - Fax:908-277-1058
Practice Address - Street 1:407 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2603
Practice Address - Country:US
Practice Address - Phone:908-277-0399
Practice Address - Fax:908-277-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS003374003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0328520001Medicare NSC