Provider Demographics
NPI:1376688010
Name:DEVARIA LLC
Entity Type:Organization
Organization Name:DEVARIA LLC
Other - Org Name:THE GALAXY DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMBHATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-453-0555
Mailing Address - Street 1:7000 KENNEDY BLVD E
Mailing Address - Street 2:M-7
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:201-453-0555
Mailing Address - Fax:201-453-0550
Practice Address - Street 1:7000 KENNEDY BLVD E
Practice Address - Street 2:M-7
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-453-0555
Practice Address - Fax:201-453-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00523900333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145223OtherPK