Healthcare Provider Details

I. General information

NPI: 1780550483
Provider Name (Legal Business Name): GANESHA05
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2025
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 US HIGHWAY 9
OLD BRIDGE NJ
08857-2690
US

IV. Provider business mailing address

3117 US HIGHWAY 9
OLD BRIDGE NJ
08857-2690
US

V. Phone/Fax

Practice location:
  • Phone: 732-679-3555
  • Fax: 732-679-6797
Mailing address:
  • Phone: 732-679-3555
  • Fax: 732-679-6797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: VIHAR PATEL
Title or Position: PHARMACIST
Credential:
Phone: 732-325-4384