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NPI Code Detail

MEDICARE: YAGNAM LLC

MEDICARE: YAGNAM 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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy28RS00328400NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12166431OTHERPK

General Provider Information

NPI Number : 1720521420
Entity Type Code : Organization
Provider Name (Legal Business Name) : YAGNAM LLC
Provider Business Mailing Address
First Line : 500 RIVER ST
Second Line :
City : PATERSON
State : NJ
Zip : 07524-1903
Country : US
Telephone Number : 973-279-2800
Fax Number : 973-279-2197
Provider Business Practice Location Address
First Line : 500 RIVER ST
Second Line :
City : PATERSON
State : NJ
Zip : 07524-1903
Country : US
Telephone Number : 973-279-2800
Fax Number : 973-279-2197
Authorized Official
Title or Position : PHARMACIST IN CHARGE
Name : PRATIK PATEL
Credential : PHARMD
Telephone Number : 973-279-2800
Provider Enumeration Date : 11/29/2016
Last Update Date : 04/25/2017

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Directions to “YAGNAM LLC ” Practice Location

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