Provider Demographics
NPI:1417005414
Name:SIRI PHARMACY AND MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:SIRI PHARMACY AND MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHCST
Authorized Official - Prefix:
Authorized Official - First Name:KHAJSNDRANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-219-0160
Mailing Address - Street 1:2969 RIVER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31815 SOUTHFIELD RD
Practice Address - Street 2:MED VILLAGE STE 22
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-203-0399
Practice Address - Fax:248-203-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
MI53010085653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2369317OtherOTHER ID NUMBER
2369317OtherOTHER ID NUMBER-COMMERCIAL NUMBER