Healthcare Provider Details

I. General information

NPI: 1386984326
Provider Name (Legal Business Name): SHRISHA RX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29211 HEATHERCLIFF RD
MALIBU CA
90265-4145
US

IV. Provider business mailing address

29211 HEATHERCLIFF RD
MALIBU CA
90265-4145
US

V. Phone/Fax

Practice location:
  • Phone: 310-457-9707
  • Fax:
Mailing address:
  • Phone: 310-457-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 41309
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SEEMA C PATEL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 818-389-6381