Provider Demographics
NPI:1629183660
Name:SHREE YOGESHWAR INC
Entity Type:Organization
Organization Name:SHREE YOGESHWAR INC
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:VORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-832-6539
Mailing Address - Street 1:365 FORSYTHE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3304
Mailing Address - Country:US
Mailing Address - Phone:409-832-6539
Mailing Address - Fax:409-838-4765
Practice Address - Street 1:365 FORSYTHE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3304
Practice Address - Country:US
Practice Address - Phone:409-832-6539
Practice Address - Fax:409-838-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX227833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144181Medicaid
2104350OtherPK