Healthcare Provider Details

I. General information

NPI: 1568896785
Provider Name (Legal Business Name): SHREEJI ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 PAWTUCKET BLVD STE 3
LOWELL MA
01854-1070
US

IV. Provider business mailing address

1275 PAWTUCKET BLVD STE 3
LOWELL MA
01854-1070
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-6666
  • Fax: 978-452-6667
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS89892
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MINESH BRAHMBHATT
Title or Position: PHARMACY MANAGER
Credential:
Phone: 978-452-6666