Healthcare Provider Details

I. General information

NPI: 1275939746
Provider Name (Legal Business Name): LL PHARMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9252 KENNEDY BLVD UNIT 3
NORTH BERGEN NJ
07047-9300
US

IV. Provider business mailing address

9252 KENNEDY BLVD UNIT 3
NORTH BERGEN NJ
07047-9300
US

V. Phone/Fax

Practice location:
  • Phone: 201-624-8015
  • Fax: 201-624-8016
Mailing address:
  • Phone: 201-624-8015
  • Fax: 201-624-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00737000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIRAN K CHENNA
Title or Position: PRESIDENT
Credential:
Phone: 551-998-2115