Provider Demographics
NPI:1689815508
Name:EASY PHARMACY AT SBB LLC
Entity Type:Organization
Organization Name:EASY PHARMACY AT SBB LLC
Other - Org Name:EASY PHARMACY & SURGICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARVATRAO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-667-7007
Mailing Address - Street 1:34 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08880-1466
Mailing Address - Country:US
Mailing Address - Phone:732-667-7007
Mailing Address - Fax:732-667-7017
Practice Address - Street 1:34 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08880-1466
Practice Address - Country:US
Practice Address - Phone:732-667-7007
Practice Address - Fax:732-667-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTBD332B00000X, 333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0217395Medicaid
NJ12345678Medicaid