Provider Demographics
NPI:1982428009
Name:VANAM PHARMACY INC
Entity type:Organization
Organization Name:VANAM PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANIGIRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-871-3004
Mailing Address - Street 1:2804 FREDERICK DOUGLASS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-2102
Mailing Address - Country:US
Mailing Address - Phone:212-871-3004
Mailing Address - Fax:212-871-2930
Practice Address - Street 1:2804 FREDERICK DOUGLASS BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-2102
Practice Address - Country:US
Practice Address - Phone:212-871-3004
Practice Address - Fax:212-871-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy