Provider Demographics
NPI:1679062756
Name:SHRI HARI RX INC
Entity Type:Organization
Organization Name:SHRI HARI RX INC
Other - Org Name:CORONA VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-365-3434
Mailing Address - Street 1:81848 VILLA PALAZZO
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-7715
Mailing Address - Country:US
Mailing Address - Phone:951-365-3434
Mailing Address - Fax:951-905-1609
Practice Address - Street 1:2079 COMPTON AVE
Practice Address - Street 2:STE 105
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7284
Practice Address - Country:US
Practice Address - Phone:951-365-3434
Practice Address - Fax:951-905-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
CA561293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177503OtherPK