Provider Demographics
NPI:1760490395
Name:KRISHNA PHARMACY INC
Entity Type:Organization
Organization Name:KRISHNA PHARMACY INC
Other - Org Name:WALDWICK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANANI
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR
Authorized Official - Phone:201-445-1100
Mailing Address - Street 1:16 E PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-2008
Mailing Address - Country:US
Mailing Address - Phone:201-445-1100
Mailing Address - Fax:201-652-2455
Practice Address - Street 1:16 E PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-2008
Practice Address - Country:US
Practice Address - Phone:201-445-1100
Practice Address - Fax:201-652-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NJ28RS006832003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128944OtherPK
NJ0279692Medicaid
2128944OtherPK