Provider Demographics
NPI:1699186338
Name:SHIVSAI RX LLC
Entity Type:Organization
Organization Name:SHIVSAI RX LLC
Other - Org Name:SANFORD DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-323-7922
Mailing Address - Street 1:1808 S FRENCH AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771
Mailing Address - Country:US
Mailing Address - Phone:407-323-7922
Mailing Address - Fax:407-323-7927
Practice Address - Street 1:1808 S FRENCH AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771
Practice Address - Country:US
Practice Address - Phone:407-323-7922
Practice Address - Fax:407-323-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013317100Medicaid
FLPH28250OtherPHARMACY LICENSE