MEDICARE: TTV PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	28RS00745700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2156096	OTHER		PK

General Provider Information

NPI Number	:	1295190114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TTV PHARMACY INC

Provider Business Mailing Address
First Line	:	406 37TH ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4804
Country	:	US
Telephone Number	:	201-453-3500
Fax Number	:	201-453-3553

Provider Business Practice Location Address
First Line	:	406 37TH ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4804
Country	:	US
Telephone Number	:	201-453-3500
Fax Number	:	201-453-3553

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUBBA NAGELI
Credential	:
Telephone Number	:	201-453-3500

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	03/31/2016

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Directions to “TTV PHARMACY INC ” Practice Location

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