Provider Demographics
NPI:1871683599
Name:SVS PHARMACY INC.
Entity Type:Organization
Organization Name:SVS PHARMACY INC.
Other - Org Name:LIBERTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-568-7868
Mailing Address - Street 1:1 TENAFLY RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2209
Mailing Address - Country:US
Mailing Address - Phone:201-568-7868
Mailing Address - Fax:201-568-5857
Practice Address - Street 1:1 TENAFLY RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2209
Practice Address - Country:US
Practice Address - Phone:201-568-7868
Practice Address - Fax:201-568-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS006550003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0093556Medicaid
NJ5595780001Medicare NSC