Healthcare Provider Details

I. General information

NPI: 1598863755
Provider Name (Legal Business Name): KING-RAJ PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E KINGSBRIDGE RD
BRONX NY
10468-7504
US

IV. Provider business mailing address

58 E KINGSBRIDGE RD
BRONX NY
10468-7504
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-8371
  • Fax: 718-933-6677
Mailing address:
  • Phone: 718-584-8371
  • Fax: 718-933-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number01938
License Number StateNY

VIII. Authorized Official

Name: APPARAO MALLA
Title or Position: PHARMACIST/PRESIDENT
Credential: M.PHARM, PH.D
Phone: 718-584-8371