Provider Demographics
NPI:1952358822
Name:SANJIVANI INC.
Entity Type:Organization
Organization Name:SANJIVANI INC.
Other - Org Name:THE APOTHECARY SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PARIKSHIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-459-9499
Mailing Address - Street 1:712 DALLAS HWY
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1203
Mailing Address - Country:US
Mailing Address - Phone:770-459-9499
Mailing Address - Fax:770-459-9803
Practice Address - Street 1:712 DALLAS HWY
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1203
Practice Address - Country:US
Practice Address - Phone:770-459-9499
Practice Address - Fax:770-459-9803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GA0082643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00806803Medicaid
GA1245460001Medicare NSC