Provider Demographics
NPI:1326344169
Name:SRK PHARMACY LLC
Entity Type:Organization
Organization Name:SRK PHARMACY LLC
Other - Org Name:DANIELS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-774-3214
Mailing Address - Street 1:42 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2917
Mailing Address - Country:US
Mailing Address - Phone:860-774-3214
Mailing Address - Fax:860-774-2426
Practice Address - Street 1:42 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2917
Practice Address - Country:US
Practice Address - Phone:860-774-3214
Practice Address - Fax:860-774-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY00016113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy