Provider Demographics
NPI:1841376761
Name:ANJANA PHARMACY LLC
Entity type:Organization
Organization Name:ANJANA PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:NANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-620-7220
Mailing Address - Street 1:PO BOX 3543
Mailing Address - Street 2:450 S DENTON TAP RD
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019
Mailing Address - Country:US
Mailing Address - Phone:214-374-3559
Mailing Address - Fax:214-376-6975
Practice Address - Street 1:2130 E LEDBETTER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:214-374-3559
Practice Address - Fax:214-376-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX275453336C0003X
TX3106083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130863OtherPK
TX470464Medicaid