Provider Demographics
NPI:1477589703
Name:BALAJI DRUGS INCORPORATED
Entity Type:Organization
Organization Name:BALAJI DRUGS INCORPORATED
Other - Org Name:MAIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KALYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANDU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D RPH
Authorized Official - Phone:732-491-3367
Mailing Address - Street 1:1206 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1331
Mailing Address - Country:US
Mailing Address - Phone:732-449-6157
Mailing Address - Fax:732-449-1349
Practice Address - Street 1:1206 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1331
Practice Address - Country:US
Practice Address - Phone:732-449-6157
Practice Address - Fax:732-449-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006668003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0126951Medicaid
2056507OtherPK
NJ0126951Medicaid