Healthcare Provider Details

I. General information

NPI: 1366501504
Provider Name (Legal Business Name): OM SHRI CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 N LAPEER RD
NORTH BRANCH MI
48461-9730
US

IV. Provider business mailing address

6002 N LAPEER RD
NORTH BRANCH MI
48461-9730
US

V. Phone/Fax

Practice location:
  • Phone: 810-793-5006
  • Fax: 810-793-5101
Mailing address:
  • Phone: 810-793-5006
  • Fax: 810-793-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301007648
License Number StateMI

VIII. Authorized Official

Name: MR. NUTAN MOTICHAND SHAH
Title or Position: OFFICER
Credential: R PH
Phone: 810-793-5006