Provider Demographics
NPI:1932134509
Name:VLV MED PHARMACY INC
Entity Type:Organization
Organization Name:VLV MED PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMADEVI
Authorized Official - Middle Name:VC
Authorized Official - Last Name:JONNALAGADDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-923-7530
Mailing Address - Street 1:4085 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1532
Mailing Address - Country:US
Mailing Address - Phone:212-923-7530
Mailing Address - Fax:212-923-7550
Practice Address - Street 1:4085 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1532
Practice Address - Country:US
Practice Address - Phone:212-923-7530
Practice Address - Fax:212-923-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018488333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00876944Medicaid
3382417OtherNABP
4920750001Medicare ID - Type Unspecified