Provider Demographics
NPI:1790223436
Name:MORRISANIA PHARMACY INC
Entity Type:Organization
Organization Name:MORRISANIA PHARMACY INC
Other - Org Name:V V PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMMAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-538-7600
Mailing Address - Street 1:3593 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456
Mailing Address - Country:US
Mailing Address - Phone:718-538-7600
Mailing Address - Fax:718-538-7602
Practice Address - Street 1:3593 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3403
Practice Address - Country:US
Practice Address - Phone:718-538-7600
Practice Address - Fax:718-538-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0349383336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166935OtherPK