Provider Demographics
NPI:1568902724
Name:BALASAI PHARMACY LLC
Entity Type:Organization
Organization Name:BALASAI PHARMACY LLC
Other - Org Name:DURHAM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SREENADHA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:BOMMU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-224-1234
Mailing Address - Street 1:5826 FAYETTEVILLE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8684
Mailing Address - Country:US
Mailing Address - Phone:919-224-1234
Mailing Address - Fax:919-224-2345
Practice Address - Street 1:5826 FAYETTEVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8684
Practice Address - Country:US
Practice Address - Phone:919-224-1234
Practice Address - Fax:919-224-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC131903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy