MEDICARE: SHRI GANESHJI 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	28RS00577200	NJ

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

General Provider Information

NPI Number	:	1578542858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHRI GANESHJI PHARMACY, INC.

Provider Business Mailing Address
First Line	:	5005 BERGLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5563
Country	:	US
Telephone Number	:	201-867-0615
Fax Number	:

Provider Business Practice Location Address
First Line	:	5005 BERGLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5563
Country	:	US
Telephone Number	:	201-867-0615
Fax Number	:

Authorized Official
Title or Position	:	RP IN CHARGE
Name	:	MR. CARLOS ALMANZA
Credential	:	R.P.
Telephone Number	:	201-867-0615

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	08/22/2020

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