Provider Demographics
NPI:1922064567
Name:VLV ORANGE PHARMACY INC
Entity Type:Organization
Organization Name:VLV ORANGE PHARMACY INC
Other - Org Name:E&M PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDALI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:973-677-2800
Mailing Address - Street 1:205 S ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3401
Mailing Address - Country:US
Mailing Address - Phone:973-677-2800
Mailing Address - Fax:973-674-8864
Practice Address - Street 1:205 S ESSEX AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050
Practice Address - Country:US
Practice Address - Phone:973-677-2800
Practice Address - Fax:973-674-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-22
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI5541332B00000X
NJ55413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7494416Medicaid
NJ7494408Medicaid
NJ7494416Medicaid