Provider Demographics
NPI:1316960776
Name:SHREE BHAVINI PHARMACY INC
Entity type:Organization
Organization Name:SHREE BHAVINI PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BINDESH K
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-345-3991
Mailing Address - Street 1:422 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1808
Mailing Address - Country:US
Mailing Address - Phone:973-345-3991
Mailing Address - Fax:973-345-0443
Practice Address - Street 1:422 10TH AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1808
Practice Address - Country:US
Practice Address - Phone:973-345-3991
Practice Address - Fax:973-345-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006813003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0179175Medicaid
2123847OtherPK
2123847OtherPK