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General NPI Number Information
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NPI Number | 1598087272
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Entity Type | Individual
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Provider Name | VIJAY KUMAR PAMIDIMUKKALA
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Gender | Male
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 4318 13TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11219-1338
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Country | US
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Telephone | 718-686-0047
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Fax | 718-686-0166
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Provider Business Mailing Address
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Address Line | 3 PENROSE CT
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City | EDISON
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State | NJ
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Zip | 08820-1618
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Country | US
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Telephone | 732-499-0179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 032243
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License Number State | NY
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