Provider Demographics
NPI:1063834430
Name:JAI SAI VENKATESWARA PHARMACY LLC
Entity Type:Organization
Organization Name:JAI SAI VENKATESWARA PHARMACY LLC
Other - Org Name:HARRY'S PHARMACY & SURGICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SRIHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:VUTUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-565-2300
Mailing Address - Street 1:634 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4544
Mailing Address - Country:US
Mailing Address - Phone:516-565-2300
Mailing Address - Fax:516-565-2605
Practice Address - Street 1:634 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4544
Practice Address - Country:US
Practice Address - Phone:516-565-2300
Practice Address - Fax:516-565-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7087350001Medicare NSC