Provider Demographics
NPI:1326917097
Name:SHREE LAXMI VINAYAK LLC
Entity type:Organization
Organization Name:SHREE LAXMI VINAYAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-538-2181
Mailing Address - Street 1:307 W NORTH WATER ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-1211
Mailing Address - Country:US
Mailing Address - Phone:920-538-2181
Mailing Address - Fax:
Practice Address - Street 1:307 W NORTH WATER ST STE A
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-1211
Practice Address - Country:US
Practice Address - Phone:920-538-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-01
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy