Provider Demographics
NPI:1508964800
Name:KRISHNANI CORPORATION
Entity Type:Organization
Organization Name:KRISHNANI CORPORATION
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:203-929-8668
Mailing Address - Street 1:202 LEAVENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1809
Mailing Address - Country:US
Mailing Address - Phone:203-929-8668
Mailing Address - Fax:203-929-4599
Practice Address - Street 1:202 LEAVENWORTH RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1809
Practice Address - Country:US
Practice Address - Phone:203-929-8668
Practice Address - Fax:203-929-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1170CT332B00000X
CT11703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0709925OtherNCPDP NUMBER
CT0709925OtherNCPDP NUMBER
CTBK8089650OtherPHARMACY DEA #