Provider Demographics
NPI:1740609338
Name:VAKRATUNDA INC.
Entity Type:Organization
Organization Name:VAKRATUNDA INC.
Other - Org Name:BERGEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RASIK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGRECHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-992-1951
Mailing Address - Street 1:23 CANOE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-6121
Mailing Address - Country:US
Mailing Address - Phone:973-273-1100
Mailing Address - Fax:
Practice Address - Street 1:194 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-2809
Practice Address - Country:US
Practice Address - Phone:973-273-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006397003336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0039039Medicaid
2145143OtherPK
5192940001Medicare NSC