Provider Demographics
NPI:1790140192
Name:SG HEALTH
Entity Type:Organization
Organization Name:SG HEALTH
Other - Org Name:VIVA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SEDEF
Authorized Official - Middle Name:
Authorized Official - Last Name:GULSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-980-9444
Mailing Address - Street 1:503 S OLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-2102
Mailing Address - Country:US
Mailing Address - Phone:609-337-7152
Mailing Address - Fax:609-337-7153
Practice Address - Street 1:503 S OLDEN AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-2102
Practice Address - Country:US
Practice Address - Phone:609-337-7152
Practice Address - Fax:609-337-7153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00747700333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158779OtherPK