Provider Demographics
NPI:1457924128
Name:NIKISAAGA LLC
Entity Type:Organization
Organization Name:NIKISAAGA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANISHKUMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-495-5705
Mailing Address - Street 1:4050 DERRICO PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-2839
Mailing Address - Country:US
Mailing Address - Phone:201-744-0481
Mailing Address - Fax:
Practice Address - Street 1:3973 SAINT CHARLES PKWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2683
Practice Address - Country:US
Practice Address - Phone:248-495-5705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy