Provider Demographics
NPI:1639311210
Name:SHRI HARI RX INC
Entity Type:Organization
Organization Name:SHRI HARI RX INC
Other - Org Name:RIVERWALK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAPAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-442-8078
Mailing Address - Street 1:4234 RIVERWALK PARKWAY
Mailing Address - Street 2:STE 130
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505
Mailing Address - Country:US
Mailing Address - Phone:951-352-3030
Mailing Address - Fax:866-610-6154
Practice Address - Street 1:4234 RIVERWALK PARKWAY
Practice Address - Street 2:STE 130
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505
Practice Address - Country:US
Practice Address - Phone:951-352-3030
Practice Address - Fax:866-610-6154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHRI HARI RX INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336L0003X, 3336M0003X
CAPHY 498583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5634008OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1639311210Medicaid
CA1639311210Medicaid