Healthcare Provider Details

I. General information

NPI: 1235680455
Provider Name (Legal Business Name): SAI DURGA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 SPENCER PL
SCARSDALE NY
10583-4110
US

IV. Provider business mailing address

23 SPENCER PL
SCARSDALE NY
10583-4110
US

V. Phone/Fax

Practice location:
  • Phone: 914-723-2808
  • Fax: 914-723-2781
Mailing address:
  • Phone: 914-723-2808
  • Fax: 914-723-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number035112
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAJ KANTAMNENI
Title or Position: MEMBER
Credential:
Phone: 914-723-2808