=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417469149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAI CHANDI PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2017
-----------------------------------------------------
Last Update Date | 11/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 198 MARKET ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-639-1900
-----------------------------------------------------
Fax | 973-639-1901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 198 MARKET ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-639-1900
-----------------------------------------------------
Fax | 973-639-1901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. RAJASEKHAR KANTAMNENI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-639-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------