Provider Demographics
NPI:1649652819
Name:AKSHARVATIKA LLC
Entity type:Organization
Organization Name:AKSHARVATIKA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-970-5277
Mailing Address - Street 1:347E MATAWAN RD
Mailing Address - Street 2:STE 13
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3926
Mailing Address - Country:US
Mailing Address - Phone:732-970-5277
Mailing Address - Fax:732-970-5276
Practice Address - Street 1:347E MATAWAN RD
Practice Address - Street 2:STE 13
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3926
Practice Address - Country:US
Practice Address - Phone:732-970-5277
Practice Address - Fax:732-970-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X, 3336S0011X, 3336C0004X
NJ28RS007487003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159972OtherPK
NJ0540838Medicaid