Provider Demographics
NPI:1932639440
Name:SVI PHARMA
Entity Type:Organization
Organization Name:SVI PHARMA
Other - Org Name:IDEAL MARKETPLACE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER IDEAL MARKETPLACE PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RAMASWAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-928-4576
Mailing Address - Street 1:85 ACKERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1501
Mailing Address - Country:US
Mailing Address - Phone:973-928-3400
Mailing Address - Fax:973-928-4010
Practice Address - Street 1:85 ACKERMAN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1501
Practice Address - Country:US
Practice Address - Phone:973-928-3400
Practice Address - Fax:973-928-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-16
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007566003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169828OtherPK