Provider Demographics
NPI:1720273428
Name:SIRI PHARMACY &MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:SIRI PHARMACY &MEDICAL EQUIPMENT INC.
Other - Org Name:SIRI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KHAJENDRANATH
Authorized Official - Middle Name:
Authorized Official - Last Name:ATLURI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-219-0160
Mailing Address - Street 1:2969 RIVER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2394
Mailing Address - Country:US
Mailing Address - Phone:248-219-0160
Mailing Address - Fax:248-203-0388
Practice Address - Street 1:418 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1425
Practice Address - Country:US
Practice Address - Phone:248-219-0160
Practice Address - Fax:248-203-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301008684332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIFS0449555OtherDEA