Healthcare Provider Details

I. General information

NPI: 1205913597
Provider Name (Legal Business Name): MALANDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CEDAR GROVE LN
SOMERSET NJ
08873-1331
US

IV. Provider business mailing address

7 CEDAR GROVE LN
SOMERSET NJ
08873-1331
US

V. Phone/Fax

Practice location:
  • Phone: 732-907-6780
  • Fax: 732-356-4398
Mailing address:
  • Phone: 732-907-6780
  • Fax: 732-356-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number28RS00431800
License Number StateNJ

VIII. Authorized Official

Name: TERRY MALANDA
Title or Position: RPH
Credential: RPH
Phone: 732-735-0825