Provider Demographics
NPI:1114224870
Name:SHREE RADHEKRISHNA LLC
Entity Type:Organization
Organization Name:SHREE RADHEKRISHNA LLC
Other - Org Name:CADILA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:586-817-0497
Mailing Address - Street 1:23832 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-8000
Mailing Address - Country:US
Mailing Address - Phone:248-557-9333
Mailing Address - Fax:248-557-4970
Practice Address - Street 1:23832 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-8000
Practice Address - Country:US
Practice Address - Phone:248-557-9333
Practice Address - Fax:248-557-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
MI53010095153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128893OtherPK
MI6924750001Medicare NSC