Healthcare Provider Details

I. General information

NPI: 1275612855
Provider Name (Legal Business Name): SHASAM DRUGS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 01/30/2022
Certification Date: 01/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 MAIN ST
BIRCH RUN MI
48415-7734
US

IV. Provider business mailing address

8501 MAIN ST
BIRCH RUN MI
48415-7734
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-9231
  • Fax: 989-624-4093
Mailing address:
  • Phone: 989-624-9231
  • Fax: 989-624-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010658
License Number StateMI

VIII. Authorized Official

Name: MURALI GINJUPALLI
Title or Position: PRESIDENT
Credential:
Phone: 989-624-9231