Provider Demographics
NPI:1457466484
Name:JAI CHAMUNDA INC
Entity Type:Organization
Organization Name:JAI CHAMUNDA INC
Other - Org Name:CORNER DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHAVESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-264-8033
Mailing Address - Street 1:7454 BRINDLE TRL
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-4035
Mailing Address - Country:US
Mailing Address - Phone:231-264-8033
Mailing Address - Fax:231-264-6484
Practice Address - Street 1:154 RIVER ST
Practice Address - Street 2:
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629-9614
Practice Address - Country:US
Practice Address - Phone:231-264-8033
Practice Address - Fax:231-264-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010109943336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457466484Medicaid
2164429OtherPK