=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144239302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AJANTA PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 03/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2718 8TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10030-3706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-283-6228
-----------------------------------------------------
Fax | 212-281-2635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2718 8TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10030-3706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-283-6228
-----------------------------------------------------
Fax | 212-281-2635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | VENKATESWARLU MARELLA
-----------------------------------------------------
Credential | B.PHARM,M.PHARM
-----------------------------------------------------
Telephone | 212-283-6228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 018218
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------