Provider Demographics
NPI:1013053628
Name:SHAMBHAVI INC
Entity Type:Organization
Organization Name:SHAMBHAVI INC
Other - Org Name:TREWORGY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRABHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-949-3655
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-0930
Mailing Address - Country:US
Mailing Address - Phone:207-454-3300
Mailing Address - Fax:207-454-2268
Practice Address - Street 1:333 MAIN ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1809
Practice Address - Country:US
Practice Address - Phone:207-454-3300
Practice Address - Fax:207-454-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
ME500014283336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130893OtherPK
2130893OtherPK