Provider Demographics
NPI:1962417592
Name:SAI COOPERS LLC
Entity type:Organization
Organization Name:SAI COOPERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-602-0499
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-0661
Mailing Address - Country:US
Mailing Address - Phone:910-245-4672
Mailing Address - Fax:910-245-4797
Practice Address - Street 1:3353 US HWY 1
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394
Practice Address - Country:US
Practice Address - Phone:910-245-4672
Practice Address - Fax:910-245-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116653336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0635193Medicaid
2148442OtherPK
NC7701552Medicaid
0504600001Medicare NSC