Provider Demographics
NPI:1164134656
Name:MELROSE AVE PHARMACY LLC
Entity Type:Organization
Organization Name:MELROSE AVE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PUJITHA REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NALANAGULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-915-5656
Mailing Address - Street 1:899 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4166
Mailing Address - Country:US
Mailing Address - Phone:917-915-5656
Mailing Address - Fax:718-292-4583
Practice Address - Street 1:899 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4166
Practice Address - Country:US
Practice Address - Phone:917-915-5656
Practice Address - Fax:718-292-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy