Provider Demographics
NPI:1740565357
Name:ANIKA PHARMACY CORP
Entity Type:Organization
Organization Name:ANIKA PHARMACY CORP
Other - Org Name:LORVEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARENDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-649-9535
Mailing Address - Street 1:13929 BALTIMORE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5045
Mailing Address - Country:US
Mailing Address - Phone:301-490-8311
Mailing Address - Fax:301-490-8244
Practice Address - Street 1:13929 BALTIMORE AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5045
Practice Address - Country:US
Practice Address - Phone:301-490-8311
Practice Address - Fax:301-490-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP055903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136162OtherNCPDP PROVIDER IDENTIFICATION NUMBER