Provider Demographics
NPI:1174683999
Name:AMITA CORP
Entity Type:Organization
Organization Name:AMITA CORP
Other - Org Name:KOMISHANE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GHANSHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DATWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-399-0900
Mailing Address - Street 1:199 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3020
Mailing Address - Country:US
Mailing Address - Phone:973-399-0900
Mailing Address - Fax:973-399-0902
Practice Address - Street 1:199 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3020
Practice Address - Country:US
Practice Address - Phone:973-399-0900
Practice Address - Fax:973-399-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS0032200333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3123976OtherNABP
NJ0623650001Medicare NSC