Provider Demographics
NPI:1962511675
Name:ULI RX INC
Entity Type:Organization
Organization Name:ULI RX INC
Other - Org Name:IRVING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ULLAS
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:THANNICKAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPL
Authorized Official - Phone:973-742-8186
Mailing Address - Street 1:382 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501
Mailing Address - Country:US
Mailing Address - Phone:973-742-8186
Mailing Address - Fax:973-742-8187
Practice Address - Street 1:382 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501
Practice Address - Country:US
Practice Address - Phone:973-742-8186
Practice Address - Fax:973-742-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02394600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0014630Medicaid
NJ0014664Medicaid
NJ0014630Medicaid