Provider Demographics
NPI:1801244504
Name:AROW VENTURES LLC
Entity type:Organization
Organization Name:AROW VENTURES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PIC, AO, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMMALA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-545-4333
Mailing Address - Street 1:110 W K ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2939
Mailing Address - Country:US
Mailing Address - Phone:360-545-4333
Mailing Address - Fax:360-545-4407
Practice Address - Street 1:110 W K ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2939
Practice Address - Country:US
Practice Address - Phone:360-545-4333
Practice Address - Fax:360-545-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 333600000X
WAPHAR.CF.606447303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160489OtherPK