1811413453 NPI number — SHREEJI PHARMACY LLC

Table of content: (NPI 1811413453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811413453 NPI number — SHREEJI PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHREEJI PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811413453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
479 NEWMAN SPRINGS RD STE A-102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07746-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-946-1600
Provider Business Mailing Address Fax Number:
732-946-1001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
479 COUNTY HIGHWAY 520
Provider Second Line Business Practice Location Address:
A-102
Provider Business Practice Location Address City Name:
MARLBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-946-1600
Provider Business Practice Location Address Fax Number:
732-946-1001
Provider Enumeration Date:
08/15/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
KEYUR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-946-1600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 28RS00758800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 28RS00758800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 28RS00758800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0605115 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".