Healthcare Provider Details

I. General information

NPI: 1457466484
Provider Name (Legal Business Name): JAI CHAMUNDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 RIVER ST
ELK RAPIDS MI
49629-9614
US

IV. Provider business mailing address

7454 BRINDLE TRL
KALAMAZOO MI
49009-4035
US

V. Phone/Fax

Practice location:
  • Phone: 231-264-8033
  • Fax: 231-264-6484
Mailing address:
  • Phone: 231-264-8033
  • Fax: 231-264-6484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301010994
License Number StateMI

VIII. Authorized Official

Name: BHAVESH PATEL
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 231-264-8033