Provider Demographics
NPI:1023298676
Name:ASR HEALTH INC.
Entity type:Organization
Organization Name:ASR HEALTH INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SRINVASA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KANDRU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-946-4700
Mailing Address - Street 1:12677 HESPERIA ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:VICTORYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395
Mailing Address - Country:US
Mailing Address - Phone:760-962-1200
Mailing Address - Fax:760-962-1222
Practice Address - Street 1:18522 US HIGHWAY 18
Practice Address - Street 2:STE 103
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2321
Practice Address - Country:US
Practice Address - Phone:760-946-4700
Practice Address - Fax:760-946-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57282Medicaid
2112986OtherPK