Organization
SIDDHI GANESHA INC
Active
Other names
BERGEN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DEVANG RASIK NAGRECHA (PRESIDENT)
(973) 632-4994
Entity
Organization
Contact information
Practice address
655 E JERSEY ST, ELIZABETH, NJ 07206-1259
(908) 994-9300
(908) 994-9305
Mailing address
23 CANOE BROOK DR, LIVINGSTON, NJ 07039-6121
(973) 632-4994
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28RS00764500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177999
PK
—
Enumeration date
06/06/2018
Last updated
07/21/2020
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