Healthcare Provider Details

I. General information

NPI: 1467249250
Provider Name (Legal Business Name): SHIVANKAR VAJINEPALLI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES ST
EDISON NJ
08820-3947
US

IV. Provider business mailing address

53 LEAH WAY
PARSIPPANY NJ
07054-3448
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04394100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: