Provider Demographics
NPI:1215046040
Name:ESSGEE ALPHA CORP
Entity Type:Organization
Organization Name:ESSGEE ALPHA CORP
Other - Org Name:ALPHA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SREEDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VAJINEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-528-1008
Mailing Address - Street 1:1596 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ALPHA
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-454-4362
Mailing Address - Fax:908-454-9029
Practice Address - Street 1:1596 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALPHA
Practice Address - State:NJ
Practice Address - Zip Code:08865
Practice Address - Country:US
Practice Address - Phone:908-454-4362
Practice Address - Fax:908-454-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006761003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0154938Medicaid
3103532OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3103532OtherNCPDP PROVIDER IDENTIFICATION NUMBER