Provider Demographics
NPI:1649892712
Name:JAI SIDDHI VINAYAK INC.
Entity type:Organization
Organization Name:JAI SIDDHI VINAYAK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAI
Authorized Official - Middle Name:SIDDHI
Authorized Official - Last Name:VINAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-722-0077
Mailing Address - Street 1:1489 NEW WALKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3319
Mailing Address - Country:US
Mailing Address - Phone:336-722-0077
Mailing Address - Fax:336-722-0051
Practice Address - Street 1:1489 NEW WALKERTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3319
Practice Address - Country:US
Practice Address - Phone:336-722-0077
Practice Address - Fax:336-722-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy