Provider Demographics
NPI:1225397110
Name:BOPPANA, VINOD
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:
Last Name:BOPPANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 RAMAPO VALLEY ROAD
Mailing Address - Street 2:OAKLAND DRUGS
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436
Mailing Address - Country:US
Mailing Address - Phone:201-337-7300
Mailing Address - Fax:
Practice Address - Street 1:373 RAMAPO VALLEY ROAD
Practice Address - Street 2:OAKLAND DRUGS
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436
Practice Address - Country:US
Practice Address - Phone:201-337-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03480500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist