Provider Demographics
NPI:1952356859
Name:VASAVI PHARMACY INC
Entity Type:Organization
Organization Name:VASAVI PHARMACY INC
Other - Org Name:MAST PHARMACY & SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/PIC
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:609-298-7773
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-0227
Mailing Address - Country:US
Mailing Address - Phone:609-298-7773
Mailing Address - Fax:609-298-1504
Practice Address - Street 1:338 FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1709
Practice Address - Country:US
Practice Address - Phone:609-298-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANP000069332B00000X, 3336C0003X
332BN1400X, 332BP3500X, 332BX2000X, 333600000X, 3336S0011X
NJ28RS006866003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0279617Medicaid
2129303OtherPK
NJ0191566Medicaid
NJ28RS00686600OtherPHARMACY
PANP000069OtherPHARMACY
PANP000069OtherPHARMACY
NJ28RS00686600OtherPHARMACY