| Organization Name: | IMPRIMISRX NJ, LLC |
| NPI Number: | 1396870986 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREW RICHARD BOLL (SECRETARY & CFO) |
| Mailing Address: | 1705 Route 46 Suite 6a Ledgewood |
| State: | NJ US |
| Postal Code: | 078529720 |
| Phone Number: | 8667927328 |
| Fax Number: | 8554054669 |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 06/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | 28RS00593300 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |