Provider Demographics
NPI:1043788417
Name:CROSS ROADS PHARMACY INC
Entity Type:Organization
Organization Name:CROSS ROADS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THAKKELAPALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-354-2060
Mailing Address - Street 1:700 E JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2815
Mailing Address - Country:US
Mailing Address - Phone:908-354-2060
Mailing Address - Fax:
Practice Address - Street 1:700 E JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:908-354-2060
Practice Address - Fax:908-354-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy