Provider Demographics
NPI:1275939746
Name:LL PHARMA INC
Entity Type:Organization
Organization Name:LL PHARMA INC
Other - Org Name:LIFELINE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-998-2115
Mailing Address - Street 1:9252 KENNEDY BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-9300
Mailing Address - Country:US
Mailing Address - Phone:201-624-8015
Mailing Address - Fax:201-624-8016
Practice Address - Street 1:9252 KENNEDY BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-9300
Practice Address - Country:US
Practice Address - Phone:201-624-8015
Practice Address - Fax:201-624-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007370003336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148812OtherPK