Provider Demographics
NPI:1699822759
Name:SHRI DIVYA DRUGS LLC
Entity Type:Organization
Organization Name:SHRI DIVYA DRUGS LLC
Other - Org Name:FRIO DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATAKIRAN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:KALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-261-9694
Mailing Address - Street 1:223 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061
Mailing Address - Country:US
Mailing Address - Phone:830-267-2020
Mailing Address - Fax:830-267-2019
Practice Address - Street 1:223 S OAK ST
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061
Practice Address - Country:US
Practice Address - Phone:830-267-2020
Practice Address - Fax:830-267-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX182233336C0003X
TX313883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144679Medicaid
4545197OtherNCPDP PROVIDER IDENTIFICATION NUMBER