Healthcare Provider Details

I. General information

NPI: 1265899355
Provider Name (Legal Business Name): SHREE JI CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N 3RD ST STE 101
PHOENIX AZ
85012-3053
US

IV. Provider business mailing address

3003 N 3RD ST STE 101
PHOENIX AZ
85012-3053
US

V. Phone/Fax

Practice location:
  • Phone: 480-404-9160
  • Fax: 480-758-5208
Mailing address:
  • Phone: 480-404-9160
  • Fax: 480-758-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY006743
License Number StateAZ

VIII. Authorized Official

Name: MARK MOEREMANS
Title or Position: PRESIDENT
Credential:
Phone: 480-360-7804