Healthcare Provider Details

I. General information

NPI: 1770956831
Provider Name (Legal Business Name): SSANJ RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 N OLDEN AVE
EWING NJ
08638-3209
US

IV. Provider business mailing address

1668 N OLDEN AVE
EWING NJ
08638-3209
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-2700
  • Fax: 609-896-2701
Mailing address:
  • Phone: 609-896-2700
  • Fax: 609-896-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00746500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAKSHMI MUNNANGI
Title or Position: PRESIDENT
Credential:
Phone: 609-896-2700