Provider Demographics
NPI:1720380140
Name:VJK CORP
Entity Type:Organization
Organization Name:VJK CORP
Other - Org Name:DIAMOND 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:269-226-9000
Mailing Address - Street 1:119 E PATERSON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-2530
Mailing Address - Country:US
Mailing Address - Phone:269-226-9000
Mailing Address - Fax:269-226-9033
Practice Address - Street 1:119 E PATERSON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-2530
Practice Address - Country:US
Practice Address - Phone:269-226-9000
Practice Address - Fax:269-226-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010094483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2374724OtherNCPDP PROVIDER IDENTIFICATION NUMBER