Provider Demographics
NPI:1013987940
Name:RESES PHARMACY LLC
Entity Type:Organization
Organization Name:RESES PHARMACY LLC
Other - Org Name:S.RESES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:KAMLESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VAVAIYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-965-3600
Mailing Address - Street 1:269 W WHITE HORSE PIKE
Mailing Address - Street 2:P O BOX 889
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08240
Mailing Address - Country:US
Mailing Address - Phone:609-965-3600
Mailing Address - Fax:609-965-4330
Practice Address - Street 1:269 W WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240
Practice Address - Country:US
Practice Address - Phone:609-965-3600
Practice Address - Fax:609-965-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS003475003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4311701Medicaid
NJ3163504Medicaid
NJ0608220001Medicare NSC