Provider Demographics
NPI:1073170296
Name:SHIVA LLC
Entity Type:Organization
Organization Name:SHIVA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-322-7097
Mailing Address - Street 1:354 CHARDONNAY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-9545
Mailing Address - Country:US
Mailing Address - Phone:509-788-0123
Mailing Address - Fax:509-788-0124
Practice Address - Street 1:354 CHARDONNAY AVE STE 5
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-9545
Practice Address - Country:US
Practice Address - Phone:509-788-0123
Practice Address - Fax:509-788-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy