MEDICARE: SV PHARMA INC

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
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0004X	Compounding Pharmacy
4	333600000X	Pharmacy	28RS00017400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2128076	OTHER		PK

General Provider Information

NPI Number	:	1619954443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SV PHARMA INC

Provider Business Mailing Address
First Line	:	227 OCEAN AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2613
Country	:	US
Telephone Number	:	201-433-1512
Fax Number	:	201-433-1566

Provider Business Practice Location Address
First Line	:	227 OCEAN AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2613
Country	:	US
Telephone Number	:	201-433-1512
Fax Number	:	201-433-1566

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	SUDHEER MALGIREDDY
Credential	:
Telephone Number	:	201-433-1512

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	02/27/2017

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