Healthcare Provider Details

I. General information

NPI: 1720466089
Provider Name (Legal Business Name): VLV ORANGE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S ESSEX AVE
ORANGE NJ
07050
US

IV. Provider business mailing address

205 S ESSEX AVE
ORANGE NJ
07050-3401
US

V. Phone/Fax

Practice location:
  • Phone: 973-677-2800
  • Fax:
Mailing address:
  • Phone: 973-677-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number28RS00554100
License Number StateNJ

VIII. Authorized Official

Name: MR. PRAKASH MADDALI
Title or Position: RPH
Credential:
Phone: 973-677-2800