Provider Demographics
NPI:1104831742
Name:DHANAVANTRI INC
Entity Type:Organization
Organization Name:DHANAVANTRI INC
Other - Org Name:LEXCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDREGULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:540-463-6284
Mailing Address - Street 1:146 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2356
Mailing Address - Country:US
Mailing Address - Phone:540-463-6284
Mailing Address - Fax:540-463-6393
Practice Address - Street 1:146 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2356
Practice Address - Country:US
Practice Address - Phone:540-463-6284
Practice Address - Fax:540-463-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010038373336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010129176Medicaid
2120611OtherPK
VA010127483Medicaid
VA010129176Medicaid