Provider Demographics
NPI:1053670588
Name:MEDLIFE PHARMACY INC
Entity Type:Organization
Organization Name:MEDLIFE PHARMACY INC
Other - Org Name:MEDLIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAJASEKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHUNURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-658-3636
Mailing Address - Street 1:2000 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1383
Mailing Address - Country:US
Mailing Address - Phone:732-658-3636
Mailing Address - Fax:732-658-3638
Practice Address - Street 1:2000 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1383
Practice Address - Country:US
Practice Address - Phone:732-658-3636
Practice Address - Fax:732-658-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007186003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134888OtherPK
NJ7042950001Medicare NSC