Provider Demographics
NPI:1891028759
Name:GANESHJI INC
Entity Type:Organization
Organization Name:GANESHJI INC
Other - Org Name:BE WELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHARYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-547-5100
Mailing Address - Street 1:1964 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3046
Mailing Address - Country:US
Mailing Address - Phone:248-547-5100
Mailing Address - Fax:248-547-5307
Practice Address - Street 1:1964 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-3046
Practice Address - Country:US
Practice Address - Phone:248-547-5100
Practice Address - Fax:248-547-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010091913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373227OtherNCPDP PROVIDER IDENTIFICATION NUMBER