Provider Demographics
NPI:1437164084
Name:SHREE PHARMACY INC
Entity Type:Organization
Organization Name:SHREE PHARMACY INC
Other - Org Name:SHREE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-998-2115
Mailing Address - Street 1:1624 W MONTROSE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1214
Mailing Address - Country:US
Mailing Address - Phone:773-907-0407
Mailing Address - Fax:773-907-0560
Practice Address - Street 1:1624 W MONTROSE AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1214
Practice Address - Country:US
Practice Address - Phone:773-907-0407
Practice Address - Fax:773-907-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021159OtherPK
IL=========001Medicaid
5341320001Medicare NSC