Provider Demographics
NPI:1376636225
Name:SHRI SAI R&R CORPORATION
Entity Type:Organization
Organization Name:SHRI SAI R&R CORPORATION
Other - Org Name:VILLAGE ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHANSUKHLAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:562-425-6434
Mailing Address - Street 1:5412 E VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1636
Mailing Address - Country:US
Mailing Address - Phone:562-425-6434
Mailing Address - Fax:562-496-1088
Practice Address - Street 1:5412 E VILLAGE RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1636
Practice Address - Country:US
Practice Address - Phone:562-425-6434
Practice Address - Fax:562-496-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY3602703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA360270Medicaid
CAPHA360270Medicaid