Provider Demographics
NPI:1528366192
Name:VJKR LTD
Entity Type:Organization
Organization Name:VJKR LTD
Other - Org Name:NOBLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-715-5470
Mailing Address - Street 1:5097 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1066
Mailing Address - Country:US
Mailing Address - Phone:810-715-5470
Mailing Address - Fax:810-715-5475
Practice Address - Street 1:5097 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1066
Practice Address - Country:US
Practice Address - Phone:810-715-5470
Practice Address - Fax:810-715-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010095233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2375360OtherNCPDP PROVIDER IDENTIFICATION NUMBER