Provider Demographics
NPI:1306057864
Name:PARISI, MATTHEW J JR (RPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:PARISI
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LOWER OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-1507
Mailing Address - Country:US
Mailing Address - Phone:908-647-1396
Mailing Address - Fax:
Practice Address - Street 1:794 MOUNT PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3221
Practice Address - Country:US
Practice Address - Phone:973-483-4749
Practice Address - Fax:973-482-0643
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01375800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI001375800OtherSTATE PHARMACIST LICENSE