Provider Demographics
NPI:1386362176
Name:GRANDHI LLC
Entity type:Organization
Organization Name:GRANDHI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA KUMAR
Authorized Official - Middle Name:NAGA VENKATA
Authorized Official - Last Name:JAKKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-314-2276
Mailing Address - Street 1:15 CORPORATE DR STE 1-1
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1351
Mailing Address - Country:US
Mailing Address - Phone:203-590-3737
Mailing Address - Fax:203-590-3738
Practice Address - Street 1:15 CORPORATE DR STE 1-1
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1351
Practice Address - Country:US
Practice Address - Phone:203-590-3737
Practice Address - Fax:203-590-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008065320Medicaid