Provider Demographics
NPI:1528109949
Name:B.RADHAKRISHNAN TA ZAJACS PHARMACY
Entity type:Organization
Organization Name:B.RADHAKRISHNAN TA ZAJACS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BALAKACHETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RADHAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:732-545-0582
Mailing Address - Street 1:223 GEORGE ST # 225
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1318
Mailing Address - Country:US
Mailing Address - Phone:732-545-0582
Mailing Address - Fax:732-545-0583
Practice Address - Street 1:223 GEORGE ST # 225
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1318
Practice Address - Country:US
Practice Address - Phone:732-545-0582
Practice Address - Fax:732-545-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0724106OtherDME
NJ4396804Medicaid
0568100001Medicare NSC