Provider Demographics
NPI:1609328111
Name:PHARMARAMA LLC
Entity Type:Organization
Organization Name:PHARMARAMA LLC
Other - Org Name:MT. HOLLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-914-4890
Mailing Address - Street 1:1613 ROUTE 38 UNIT 5
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-2921
Mailing Address - Country:US
Mailing Address - Phone:609-914-4890
Mailing Address - Fax:609-914-4891
Practice Address - Street 1:1613 ROUTE 38 UNIT 5
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2921
Practice Address - Country:US
Practice Address - Phone:609-914-4890
Practice Address - Fax:609-914-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00752000333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166033OtherPK