Provider Demographics
NPI:1639101249
Name:SAI PHARMA LLC
Entity Type:Organization
Organization Name:SAI PHARMA LLC
Other - Org Name:FALLSTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNAPARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-879-9000
Mailing Address - Street 1:2112 BEL AIR RD
Mailing Address - Street 2:STE 11
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2786
Mailing Address - Country:US
Mailing Address - Phone:410-879-9000
Mailing Address - Fax:410-879-9047
Practice Address - Street 1:2112 BEL AIR RD
Practice Address - Street 2:STE 11
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2786
Practice Address - Country:US
Practice Address - Phone:410-879-9000
Practice Address - Fax:410-879-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP062453336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143591OtherPK
MD523508100Medicaid
2101513OtherNCPDP