MEDICARE: SSANJ RX 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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	28RS00746500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2155445	OTHER		PK

General Provider Information

NPI Number	:	1770956831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSANJ RX INC

Provider Business Mailing Address
First Line	:	1668 N OLDEN AVE
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08638-3209
Country	:	US
Telephone Number	:	609-896-2700
Fax Number	:	609-896-2701

Provider Business Practice Location Address
First Line	:	1668 N OLDEN AVE
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08638-3209
Country	:	US
Telephone Number	:	609-896-2700
Fax Number	:	609-896-2701

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAKSHMI MUNNANGI
Credential	:
Telephone Number	:	609-896-2700

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	01/08/2020

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Directions to “SSANJ RX INC ” Practice Location

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