Provider Demographics
NPI:1912908773
Name:SHREE-SHAKTI INC
Entity Type:Organization
Organization Name:SHREE-SHAKTI INC
Other - Org Name:DEROSA PHARMACY AND HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PURNIMA
Authorized Official - Middle Name:SHAILESH
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RPH
Authorized Official - Phone:973-482-6753
Mailing Address - Street 1:570 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1346
Mailing Address - Country:US
Mailing Address - Phone:973-482-6753
Mailing Address - Fax:973-482-0356
Practice Address - Street 1:570 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1346
Practice Address - Country:US
Practice Address - Phone:973-482-6753
Practice Address - Fax:973-482-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3019705332B00000X
NJ4332504333600000X
NJ0035360335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0035360Medicaid
NJ3019705Medicaid
NJ3103239OtherNAT ASSOC BOARD PHARMACY
NJ4332504Medicaid
NJ3019705Medicaid