Healthcare Provider Details

I. General information

NPI: 1003245101
Provider Name (Legal Business Name): KINGRAJ PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E KINGSBRIDGE RD
BRONX NY
10468-7517
US

IV. Provider business mailing address

58 E KINGSBRIDGE RD
BRONX NY
10468-7517
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 Code333600000X
TaxonomyPharmacy
License Number019038
License Number StateNY

VIII. Authorized Official

Name: DR. APPARAO MALLA
Title or Position: OWNER
Credential: PHARMACIST
Phone: 718-584-8371