Provider Demographics
NPI:1770031874
Name:UMA PARVATI LLC
Entity Type:Organization
Organization Name:UMA PARVATI LLC
Other - Org Name:NILES WELLCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SANDIPKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-595-7209
Mailing Address - Street 1:70 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120
Mailing Address - Country:US
Mailing Address - Phone:269-262-4343
Mailing Address - Fax:269-262-0930
Practice Address - Street 1:70 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2200
Practice Address - Country:US
Practice Address - Phone:269-262-4343
Practice Address - Fax:269-262-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MI53010110203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164243OtherPK