=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760630958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKLAND PHARMACY RX, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2008
-----------------------------------------------------
Last Update Date | 08/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 RAMAPO VALLEY RD
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07436-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-337-7300
-----------------------------------------------------
Fax | 201-337-6188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 RAMAPO VALLEY RD
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07436-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-337-7300
-----------------------------------------------------
Fax | 201-337-6188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | SUNIL MANDALAPU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-306-9966
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RS00682500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------