Healthcare Provider Details

I. General information

NPI: 1477589703
Provider Name (Legal Business Name): BALAJI DRUGS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 3RD AVE
SPRING LAKE NJ
07762-1331
US

IV. Provider business mailing address

1206 3RD AVE
SPRING LAKE NJ
07762-1331
US

V. Phone/Fax

Practice location:
  • Phone: 732-449-6157
  • Fax: 732-449-1349
Mailing address:
  • Phone: 732-449-6157
  • Fax: 732-449-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00666800
License Number StateNJ

VIII. Authorized Official

Name: KALYAN DANDU
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D RPH
Phone: 732-491-3367