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General NPI Number Information
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NPI Number | 1619297553
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Entity Type | Organization
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Legal Business Name | VJK4 CORP
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 38525 8 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1012
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Country | US
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Telephone | 734-338-8520
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Fax | 734-338-8525
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Provider Business Mailing Address
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Address Line | 38525 8 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1012
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Country | US
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Telephone | 734-338-8520
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Fax | 734-338-8525
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Authorized Official
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Title or Position | PRESIDENT
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Name | KOMAL ACHARYA
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Credential |
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Telephone | 734-338-8520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301009356
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License Number State | MI
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