Provider Demographics
NPI:1598863755
Name:KING-RAJ PHARMACY INC.
Entity Type:Organization
Organization Name:KING-RAJ PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:APPARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MPHARM, PHD
Authorized Official - Phone:718-584-8371
Mailing Address - Street 1:58 E KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-7504
Mailing Address - Country:US
Mailing Address - Phone:718-584-8371
Mailing Address - Fax:718-933-6677
Practice Address - Street 1:58 E KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-7504
Practice Address - Country:US
Practice Address - Phone:718-584-8371
Practice Address - Fax:718-933-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X
NY01938332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01128541Medicaid
4986160001Medicare NSC