Provider Demographics
NPI:1073889861
Name:PANKTI
Entity Type:Organization
Organization Name:PANKTI
Other - Org Name:PRESIDENTIAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY INCHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:KEYUR
Authorized Official - Middle Name:KANTIBHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-782-4955
Mailing Address - Street 1:121 W BROADWAY # STOREB
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-2018
Mailing Address - Country:US
Mailing Address - Phone:973-782-4955
Mailing Address - Fax:
Practice Address - Street 1:121 W BROADWAY # STOREB
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-2018
Practice Address - Country:US
Practice Address - Phone:973-782-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007182003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00718200OtherPHARMCY LICENSE NUMER NEW JERSEY
NJ6700690001Medicare NSC