=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659429314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VEEMED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 07/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 673 BROAD ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-4410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-642-6298
-----------------------------------------------------
Fax | 973-622-4448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 673 BROAD ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07102-4410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-642-6298
-----------------------------------------------------
Fax | 973-622-4448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN-CHARGE/OWNER
-----------------------------------------------------
Name | VENKATA KODALI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-642-6298
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00694800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------