Provider Demographics
NPI:1275612855
Name:SHASAM DRUGS PC
Entity Type:Organization
Organization Name:SHASAM DRUGS PC
Other - Org Name:BIRCH RUN DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURALI
Authorized Official - Middle Name:
Authorized Official - Last Name:GINJUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-624-9231
Mailing Address - Street 1:8501 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-7734
Mailing Address - Country:US
Mailing Address - Phone:989-624-9231
Mailing Address - Fax:989-624-4093
Practice Address - Street 1:8501 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-7734
Practice Address - Country:US
Practice Address - Phone:989-624-9231
Practice Address - Fax:989-624-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X
MI53010106583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149483OtherPK
MI1035700002Medicare NSC