Healthcare Provider Details

I. General information

NPI: 1346525805
Provider Name (Legal Business Name): VINELAND PHARMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W LANDIS AVE
VINELAND NJ
08360-8104
US

IV. Provider business mailing address

315 W LANDIS AVE
VINELAND NJ
08360-8104
US

V. Phone/Fax

Practice location:
  • Phone: 856-457-5171
  • Fax:
Mailing address:
  • Phone: 856-457-5171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00715300
License Number StateNJ

VIII. Authorized Official

Name: PREM KALIDINDI
Title or Position: MEMBER/OWNER
Credential:
Phone: 917-769-8014