Healthcare Provider Details

I. General information

NPI: 1073943197
Provider Name (Legal Business Name): SARJU GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CLYDE MORRIS BLVD STE 200
ORMOND BEACH FL
32174-8182
US

IV. Provider business mailing address

305 CLYDE MORRIS BLVD SUITE # 200
ORMOND BEACH FL
32174-8181
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-1881
  • Fax: 386-310-3870
Mailing address:
  • Phone: 386-917-1881
  • Fax: 386-310-3870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH27254
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARVIND MENDPARA
Title or Position: PHARMACIST
Credential:
Phone: 386-917-1881