Provider Demographics
NPI:1831278506
Name:VIRISAAR PHARMACY INC
Entity type:Organization
Organization Name:VIRISAAR PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-679-6000
Mailing Address - Street 1:18 THROCKMORTON LN
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2570
Mailing Address - Country:US
Mailing Address - Phone:732-679-6000
Mailing Address - Fax:732-679-6004
Practice Address - Street 1:18 THROCKMORTON LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2570
Practice Address - Country:US
Practice Address - Phone:732-679-6000
Practice Address - Fax:732-679-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS006400003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3128407OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0060763Medicaid
5249380001Medicare NSC