Provider Demographics
NPI:1871820373
Name:VRAJ PHARMACY CORP
Entity Type:Organization
Organization Name:VRAJ PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:LALIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-841-9184
Mailing Address - Street 1:2040 HWY 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6103
Mailing Address - Country:US
Mailing Address - Phone:732-455-8102
Mailing Address - Fax:732-455-8104
Practice Address - Street 1:2040 HWY 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6103
Practice Address - Country:US
Practice Address - Phone:732-455-8102
Practice Address - Fax:732-455-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006984003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0222780Medicaid
NJ0222780Medicaid