Healthcare Provider Details

I. General information

NPI: 1396891438
Provider Name (Legal Business Name): SHREE SHAKTI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 BLOOMFIELD AVE
NEWARK NJ
07107-1346
US

IV. Provider business mailing address

570 BLOOMFIELD AVE
NEWARK NJ
07107-1346
US

V. Phone/Fax

Practice location:
  • Phone: 973-482-6753
  • Fax: 973-482-0356
Mailing address:
  • Phone: 973-482-6753
  • Fax: 973-482-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00312200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RS00312200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number28RS00312200
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. PURNIMA SHAH
Title or Position: OWNER
Credential: PHD, RPH
Phone: 973-482-6753