Provider Demographics
NPI:1932114337
Name:PRANAV PHARMA INC
Entity Type:Organization
Organization Name:PRANAV PHARMA INC
Other - Org Name:HACHENSACK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DUSHYANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:NANNAPANENNI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-488-1230
Mailing Address - Street 1:441 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1518
Mailing Address - Country:US
Mailing Address - Phone:201-488-1230
Mailing Address - Fax:201-488-6648
Practice Address - Street 1:441 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1518
Practice Address - Country:US
Practice Address - Phone:201-488-1230
Practice Address - Fax:201-488-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NJ28RS006293003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029459Medicaid
3121453OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0029441Medicaid
NJ0029441Medicaid