Healthcare Provider Details

I. General information

NPI: 1932114337
Provider Name (Legal Business Name): PRANAV PHARMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 PASSAIC ST
HACKENSACK NJ
07601-1518
US

IV. Provider business mailing address

441 PASSAIC ST
HACKENSACK NJ
07601-1518
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-1230
  • Fax: 201-488-6648
Mailing address:
  • Phone: 201-488-1230
  • Fax: 201-488-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00629300
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0029459
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier3121453
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER
# 3
Identifier0029441
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DUSHYANTH NANNAPANENNI
Title or Position: PIC
Credential: RPH
Phone: 201-488-1230