Provider Demographics
NPI:1932572294
Name:SHIVASHIVAANI PHARMACY LLC
Entity Type:Organization
Organization Name:SHIVASHIVAANI PHARMACY LLC
Other - Org Name:SWIFT CREEK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVISANKARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:AVULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-720-4109
Mailing Address - Street 1:2703 JONES FRANKLIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7171
Mailing Address - Country:US
Mailing Address - Phone:919-720-4109
Mailing Address - Fax:919-703-0418
Practice Address - Street 1:2703 JONES FRANKLIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7171
Practice Address - Country:US
Practice Address - Phone:919-720-4109
Practice Address - Fax:919-703-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy