Healthcare Provider Details

I. General information

NPI: 1780695205
Provider Name (Legal Business Name): SAI VENKATA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNION AVE
CRESSKILL NJ
07626-2125
US

IV. Provider business mailing address

2 UNION AVE
CRESSKILL NJ
07626-2125
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-4737
  • Fax: 201-568-0908
Mailing address:
  • Phone: 201-568-4737
  • Fax: 201-568-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00687400
License Number StateNJ

VIII. Authorized Official

Name: SREELATHA VATTIMILLI
Title or Position: PRESIDENT
Credential:
Phone: 201-568-4737