Provider Demographics
NPI:1649784646
Name:SHRI GAJANAN LLC.
Entity type:Organization
Organization Name:SHRI GAJANAN LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-298-0435
Mailing Address - Street 1:1509 S CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6250
Mailing Address - Country:US
Mailing Address - Phone:704-298-0435
Mailing Address - Fax:704-298-4951
Practice Address - Street 1:1509 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6250
Practice Address - Country:US
Practice Address - Phone:704-298-0435
Practice Address - Fax:704-298-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy