Provider Demographics
NPI:1720586746
Name:MAHANT PHARMACY LLC
Entity Type:Organization
Organization Name:MAHANT PHARMACY LLC
Other - Org Name:IVIRA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:CHINU
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-660-8847
Mailing Address - Street 1:104 HICKORY CORNER RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520
Mailing Address - Country:US
Mailing Address - Phone:609-308-2887
Mailing Address - Fax:609-308-2896
Practice Address - Street 1:104 HICKORY CORNER RD STE 106
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2460
Practice Address - Country:US
Practice Address - Phone:609-308-2887
Practice Address - Fax:609-308-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007607003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0614157Medicaid
2176035OtherPK