Healthcare Provider Details

I. General information

NPI: 1609308543
Provider Name (Legal Business Name): NIKI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HIGH ST
WALDORF MD
20602-1846
US

IV. Provider business mailing address

30 HIGH ST
WALDORF MD
20602-1846
US

V. Phone/Fax

Practice location:
  • Phone: 201-744-0481
  • Fax: 240-448-3302
Mailing address:
  • Phone: 240-448-3301
  • Fax: 240-448-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberP06652
License Number StateMD

VIII. Authorized Official

Name: KIRTAN PATEL
Title or Position: PRESIDENT
Credential:
Phone: 240-448-3301