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NPI Code Detail

MEDICARE: VIJAY KUMAR PAMIDIMUKKALA

MEDICARE: VIJAY KUMAR PAMIDIMUKKALA
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
1183500000XPharmacist032243NY

General Provider Information

NPI Number : 1598087272
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIJAY KUMAR PAMIDIMUKKALA
Provider Business Mailing Address
First Line : 3 PENROSE CT
Second Line :
City : EDISON
State : NJ
Zip : 08820-1618
Country : US
Telephone Number : 732-499-0179
Fax Number :
Provider Business Practice Location Address
First Line : 4318 13TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11219-1338
Country : US
Telephone Number : 718-686-0047
Fax Number : 718-686-0166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2010
Last Update Date : 02/22/2010

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Directions to “ VIJAY KUMAR PAMIDIMUKKALA ” Practice Location

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