Provider Demographics
NPI:1508465873
Name:WHITECROSS APOTHECARY LLC
Entity Type:Organization
Organization Name:WHITECROSS APOTHECARY LLC
Other - Org Name:INDIANA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SARVEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-687-9459
Mailing Address - Street 1:6780 INDIANA AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4270
Mailing Address - Country:US
Mailing Address - Phone:951-777-2881
Mailing Address - Fax:
Practice Address - Street 1:6780 INDIANA AVE STE 145
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4270
Practice Address - Country:US
Practice Address - Phone:951-777-2881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy