Healthcare Provider Details

I. General information

NPI: 1285802520
Provider Name (Legal Business Name): NIROSHA PUVANANAYAGAM PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 ROUTE 9
OLD BRIDGE NJ
08857
US

IV. Provider business mailing address

3500 ROUTE 9
OLD BRIDGE NJ
08857-2767
US

V. Phone/Fax

Practice location:
  • Phone: 732-607-9260
  • Fax:
Mailing address:
  • Phone: 732-607-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02881200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: