Provider Demographics
NPI:1164575296
Name:SRI SATYA SAI INC
Entity Type:Organization
Organization Name:SRI SATYA SAI INC
Other - Org Name:HAMILTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAGHUNATH
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:BHAVANAM
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARMACY
Authorized Official - Phone:609-393-1775
Mailing Address - Street 1:533 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-2625
Mailing Address - Country:US
Mailing Address - Phone:609-393-1776
Mailing Address - Fax:609-393-4426
Practice Address - Street 1:533 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-2625
Practice Address - Country:US
Practice Address - Phone:609-393-1776
Practice Address - Fax:609-393-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006504003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0073717OtherDME PROVIDER NUBER
NJ0073725Medicaid
NJ0073717OtherDME PROVIDER NUBER