Provider Demographics
NPI:1417252347
Name:RELIANCE BLOOMFIELD LLC
Entity Type:Organization
Organization Name:RELIANCE BLOOMFIELD LLC
Other - Org Name:RELIANCE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAHMAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:VALIVETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-676-1811
Mailing Address - Street 1:203 BENNINGTON TERRACE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:917-676-1811
Mailing Address - Fax:
Practice Address - Street 1:699 COTTAGE GROVE ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002
Practice Address - Country:US
Practice Address - Phone:860-242-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY00021993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy