Provider Demographics
NPI:1982376497
Name:ARDIS PHARMA LLC
Entity Type:Organization
Organization Name:ARDIS PHARMA LLC
Other - Org Name:WESTLAKE DRUG & GIFTSHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMARSENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAPPIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-327-3049
Mailing Address - Street 1:8822 PORTAGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-6416
Mailing Address - Country:US
Mailing Address - Phone:269-327-3049
Mailing Address - Fax:
Practice Address - Street 1:8822 PORTAGE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002
Practice Address - Country:US
Practice Address - Phone:269-327-3049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-03
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy