Healthcare Provider Details

I. General information

NPI: 1689815508
Provider Name (Legal Business Name): EASY PHARMACY AT SBB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 MAIN ST
SOUTH BOUND BROOK NJ
08880-1466
US

IV. Provider business mailing address

34 MAIN ST
SOUTH BOUND BROOK NJ
08880-1466
US

V. Phone/Fax

Practice location:
  • Phone: 732-667-7007
  • Fax: 732-667-7017
Mailing address:
  • Phone: 732-667-7007
  • Fax: 732-667-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberTBD
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberTBD
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberTBD
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberTBD
License Number StateNJ

VIII. Authorized Official

Name: MR. KIRAN A PARVATRAO
Title or Position: PRES & CEO
Credential: R.PH.
Phone: 732-667-7007