Provider Demographics
NPI:1063097368
Name:SHREE SHAKTI INC.
Entity type:Organization
Organization Name:SHREE SHAKTI INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PURNIMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RPH
Authorized Official - Phone:973-482-6753
Mailing Address - Street 1:570 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1346
Mailing Address - Country:US
Mailing Address - Phone:973-482-6753
Mailing Address - Fax:973-482-0356
Practice Address - Street 1:570 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1346
Practice Address - Country:US
Practice Address - Phone:973-482-6753
Practice Address - Fax:973-482-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4332504Medicaid
NJ0035360Medicaid
NJ3019705Medicaid