Provider Demographics
NPI:1750685053
Name:JAVVAJI, SRINIVAS (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:JAVVAJI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:MANOJ
Other - Middle Name:
Other - Last Name:MENGHANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACY MANAGER
Mailing Address - Street 1:2250 E.BASELINE ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042
Mailing Address - Country:US
Mailing Address - Phone:602-305-4421
Mailing Address - Fax:
Practice Address - Street 1:2250 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6947
Practice Address - Country:US
Practice Address - Phone:602-305-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist