Provider Demographics
NPI:1013296060
Name:SRI SAI GANESH INC
Entity Type:Organization
Organization Name:SRI SAI GANESH INC
Other - Org Name:SALEM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST -IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:V
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:856-935-4800
Mailing Address - Street 1:228 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-1108
Mailing Address - Country:US
Mailing Address - Phone:856-935-4800
Mailing Address - Fax:856-935-4900
Practice Address - Street 1:228 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1108
Practice Address - Country:US
Practice Address - Phone:856-935-4800
Practice Address - Fax:856-935-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00713800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RS00713800OtherPHARMACY LICENSE NUMBER
NJ28RS00713800OtherPHARMACY LICENSE NUMBER