Healthcare Provider Details

I. General information

NPI: 1386918852
Provider Name (Legal Business Name): VIJAN PHARMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 RALPH AVE
BROOKLYN NY
11233-3022
US

IV. Provider business mailing address

312 RALPH AVE
BROOKLYN NY
11233-3022
US

V. Phone/Fax

Practice location:
  • Phone: 718-774-6800
  • Fax: 718-774-1776
Mailing address:
  • Phone: 718-774-6800
  • Fax: 718-774-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number031505
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RATHNA VEERAMACHANANI
Title or Position: PRESIDENT
Credential:
Phone: 201-780-7210