Provider Demographics
NPI:1225186315
Name:SAIDURGA PHARMACY CORP
Entity type:Organization
Organization Name:SAIDURGA PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJESWARA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:DONEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:908-486-1875
Mailing Address - Street 1:1732 E SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-1729
Mailing Address - Country:US
Mailing Address - Phone:908-486-1875
Mailing Address - Fax:908-486-0521
Practice Address - Street 1:1732 E SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-1729
Practice Address - Country:US
Practice Address - Phone:908-486-1875
Practice Address - Fax:908-486-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS680100333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0197416Medicaid
NJ0197416Medicaid