Provider Demographics
NPI:1619551231
Name:RIDDHINSHIVA PHARMACY LLC.
Entity Type:Organization
Organization Name:RIDDHINSHIVA PHARMACY LLC.
Other - Org Name:COMMUNITY PHARMACY DAYTONA BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:GIRISHKUMAR PATEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:407-758-1047
Mailing Address - Street 1:1569 N NOVA RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117-3048
Mailing Address - Country:US
Mailing Address - Phone:386-872-5650
Mailing Address - Fax:386-872-5667
Practice Address - Street 1:1569 N NOVA RD
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-3048
Practice Address - Country:US
Practice Address - Phone:407-758-1047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy