Healthcare Provider Details

I. General information

NPI: 1053752659
Provider Name (Legal Business Name): PVP PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 ESSEX ST
HACKENSACK NJ
07601-3214
US

IV. Provider business mailing address

212 ESSEX ST
HACKENSACK NJ
07601-3214
US

V. Phone/Fax

Practice location:
  • Phone: 201-441-9700
  • Fax: 201-441-9702
Mailing address:
  • Phone: 201-441-9700
  • Fax: 201-441-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1797222
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1797222
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerSTATE BUSINESS LICENSE NUMBER

VIII. Authorized Official

Name: MR. NAVEEN PARUPALLI
Title or Position: MEMBER
Credential: B.S.PHARMACY
Phone: 201-441-9700