Provider Demographics
NPI:1316415755
Name:BABAJI LLC
Entity Type:Organization
Organization Name:BABAJI LLC
Other - Org Name:REIDVILLE ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:RAJKUMAR
Authorized Official - Last Name:CHOMAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-921-8366
Mailing Address - Street 1:2660 REIDVILLE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3512
Mailing Address - Country:US
Mailing Address - Phone:864-435-9400
Mailing Address - Fax:864-435-9409
Practice Address - Street 1:2660 REIDVILLE RD STE 8
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3512
Practice Address - Country:US
Practice Address - Phone:864-921-8366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-03
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC718290Medicaid
SC18290OtherPHARMACY PERMIT