Organization
VINELAND PHARMA LLC
Active
Other names
vineland pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PREM KALIDINDI (MEMBER/OWNER)
(917) 769-8014
Entity
Organization
Contact information
Practice address
315 W LANDIS AVE, VINELAND, NJ 08360-8104
(856) 457-5171
Mailing address
315 W LANDIS AVE, VINELAND, NJ 08360-8104
(856) 457-5171
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00715300
NJ
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3198214
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/17/2011
Last updated
06/07/2012
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