Provider Demographics
NPI:1083723720
Name:447 PHARMACY INC
Entity Type:Organization
Organization Name:447 PHARMACY INC
Other - Org Name:LEO HOPP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMA KRISHNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GADIRAJU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-482-7732
Mailing Address - Street 1:447 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2901
Mailing Address - Country:US
Mailing Address - Phone:973-482-7732
Mailing Address - Fax:973-482-9677
Practice Address - Street 1:447 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2901
Practice Address - Country:US
Practice Address - Phone:973-482-7732
Practice Address - Fax:973-482-9677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS003871003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056229OtherPK
NJ4377907Medicaid
0992930001Medicare NSC