Provider Demographics
NPI:1043356215
Name:SHRI SAIRAM DRUGS LLC
Entity Type:Organization
Organization Name:SHRI SAIRAM DRUGS LLC
Other - Org Name:MADISON STREET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATAKIRAN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:KALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-261-9694
Mailing Address - Street 1:395 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091
Mailing Address - Country:US
Mailing Address - Phone:904-964-7774
Mailing Address - Fax:904-964-7807
Practice Address - Street 1:395 W MADISON ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091
Practice Address - Country:US
Practice Address - Phone:904-964-7774
Practice Address - Fax:904-964-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH191053336C0003X
FLPS310353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026030400Medicaid