Provider Demographics
NPI:1083839468
Name:VERONA PHARMACY INC.
Entity Type:Organization
Organization Name:VERONA PHARMACY INC.
Other - Org Name:VERONA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHAMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-993-0978
Mailing Address - Street 1:144 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2711
Mailing Address - Country:US
Mailing Address - Phone:973-857-7710
Mailing Address - Fax:973-857-7730
Practice Address - Street 1:144 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2711
Practice Address - Country:US
Practice Address - Phone:973-857-7710
Practice Address - Fax:973-857-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS006690003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0138037Medicaid
NJRS00669000OtherSTATE LICENSE NUMBER
NJRS00669000OtherSTATE LICENSE NUMBER