MEDICARE: AJANTA PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	018218	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3380386	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1144239302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJANTA PHARMACY

Provider Business Mailing Address
First Line	:	2718 8TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-3706
Country	:	US
Telephone Number	:	212-283-6228
Fax Number	:	212-281-2635

Provider Business Practice Location Address
First Line	:	2718 8TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-3706
Country	:	US
Telephone Number	:	212-283-6228
Fax Number	:	212-281-2635

Authorized Official
Title or Position	:	PRES
Name	:	VENKATESWARLU MARELLA
Credential	:	B.PHARM,M.PHARM
Telephone Number	:	212-283-6228

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/30/2010

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Directions to “AJANTA PHARMACY ” Practice Location

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