Provider Demographics
NPI:1386888923
Name:SL PHARMACY INC
Entity type:Organization
Organization Name:SL PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-441-8470
Mailing Address - Street 1:4300 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5022
Mailing Address - Country:US
Mailing Address - Phone:201-863-0631
Mailing Address - Fax:201-863-0637
Practice Address - Street 1:4300 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5022
Practice Address - Country:US
Practice Address - Phone:201-863-0631
Practice Address - Fax:201-863-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006895003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0066281Medicaid
3196032OtherNCPDP PROVIDER IDENTIFICATION NUMBER