Healthcare Provider Details

I. General information

NPI: 1346775194
Provider Name (Legal Business Name): SAHAJANAND SWAMI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 LAWRENCEVILLE HWY STE A
DECATUR GA
30033-3206
US

IV. Provider business mailing address

2579 LAWRENCEVILLE HWY STE A
DECATUR GA
30033-3206
US

V. Phone/Fax

Practice location:
  • Phone: 770-723-9460
  • Fax: 770-723-9461
Mailing address:
  • Phone: 770-723-9460
  • Fax: 770-723-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAHESH PATEL
Title or Position: MANAGER
Credential:
Phone: 704-692-1434