Provider Demographics
NPI:1386935195
Name:BALAJI II PHARMACY INC
Entity type:Organization
Organization Name:BALAJI II PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:APPANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-874-0039
Mailing Address - Street 1:1726 MERMAID AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2765
Mailing Address - Country:US
Mailing Address - Phone:718-996-9000
Mailing Address - Fax:718-449-5106
Practice Address - Street 1:1726 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2765
Practice Address - Country:US
Practice Address - Phone:718-996-9000
Practice Address - Fax:718-449-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03332626Medicaid
5803968OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03332626Medicaid