MEDICARE: AMITVRAJ LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1336613017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMITVRAJ LLC

Provider Business Mailing Address
First Line	:	601 BROADWAY
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5906
Country	:	US
Telephone Number	:	732-222-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 BROADWAY
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5906
Country	:	US
Telephone Number	:	732-222-5400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMIT SHETH
Credential	:
Telephone Number	:	732-207-3527

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	01/16/2019

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Directions to “AMITVRAJ LLC ” Practice Location

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