Provider Demographics
NPI:1932654860
Name:PAVAN PUTRA INVESTMENT GROUP LLC
Entity Type:Organization
Organization Name:PAVAN PUTRA INVESTMENT GROUP LLC
Other - Org Name:APOLLO PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/RPH/COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:DHRUMINKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-988-7185
Mailing Address - Street 1:111 CANAL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4054
Mailing Address - Country:US
Mailing Address - Phone:912-999-6101
Mailing Address - Fax:912-777-5953
Practice Address - Street 1:111 CANAL ST STE 101
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4054
Practice Address - Country:US
Practice Address - Phone:912-999-6101
Practice Address - Fax:912-777-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-21
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0103073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163745OtherPK