Provider Demographics
NPI:1396172524
Name:SRI RX LLC
Entity type:Organization
Organization Name:SRI RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:POPURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-779-3036
Mailing Address - Street 1:140 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2530
Mailing Address - Country:US
Mailing Address - Phone:203-792-3363
Mailing Address - Fax:203-792-3364
Practice Address - Street 1:140 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2530
Practice Address - Country:US
Practice Address - Phone:203-792-3363
Practice Address - Fax:203-792-3364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY.00022083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142702OtherPK
CTD100116466Medicare PIN