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General NPI Number Information
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NPI Number | 1346525805
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Entity Type | Organization
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Legal Business Name | VINELAND PHARMA LLC
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 315 W LANDIS AVE
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City | VINELAND
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State | NJ
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Zip | 08360-8104
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Country | US
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Telephone | 856-457-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 315 W LANDIS AVE
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City | VINELAND
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State | NJ
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Zip | 08360-8104
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Country | US
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Telephone | 856-457-5171
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | PREM KALIDINDI
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Credential |
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Telephone | 917-769-8014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00715300
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License Number State | NJ
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