Provider Demographics
NPI:1639669989
Name:GANESHKRUPA LLC
Entity Type:Organization
Organization Name:GANESHKRUPA LLC
Other - Org Name:SPECIALTY RX FLW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:908-241-6337
Mailing Address - Street 1:2 BERGEN TPKE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2390
Mailing Address - Country:US
Mailing Address - Phone:908-241-6337
Mailing Address - Fax:908-634-4038
Practice Address - Street 1:502 SUNPORT LN STE 550
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-8125
Practice Address - Country:US
Practice Address - Phone:813-548-2493
Practice Address - Fax:813-278-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-12
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH313993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101668600Medicaid