Provider Demographics
NPI:1386044139
Name:ISHAAN DRUGS LLC
Entity type:Organization
Organization Name:ISHAAN DRUGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHINMAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-668-2988
Mailing Address - Street 1:722 ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3723
Mailing Address - Country:US
Mailing Address - Phone:732-257-3784
Mailing Address - Fax:732-257-3273
Practice Address - Street 1:722 ROUTE 18
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3723
Practice Address - Country:US
Practice Address - Phone:732-257-3784
Practice Address - Fax:732-257-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS003290003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147592OtherPK
NJ0450243Medicaid