Provider Demographics
NPI:1962420612
Name:SRVN PHARMACY INC
Entity type:Organization
Organization Name:SRVN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:RATHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEERAMACHANANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-437-2175
Mailing Address - Street 1:78 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2439
Mailing Address - Country:US
Mailing Address - Phone:201-437-2175
Mailing Address - Fax:201-437-4449
Practice Address - Street 1:78 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2439
Practice Address - Country:US
Practice Address - Phone:201-437-2175
Practice Address - Fax:201-437-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI025870003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0070505Medicaid
NJ0070505Medicaid
5472110001Medicare NSC