Healthcare Provider Details

I. General information

NPI: 1205310380
Provider Name (Legal Business Name): SHREE ANJANEYA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAIN ST
LANSDALE PA
19446-2028
US

IV. Provider business mailing address

801 W MAIN ST
LANSDALE PA
19446-2028
US

V. Phone/Fax

Practice location:
  • Phone: 267-737-8484
  • Fax: 267-737-8664
Mailing address:
  • Phone: 267-737-8484
  • Fax: 267-737-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAKSHMI KOMMINENI
Title or Position: MANAGER
Credential: RPH
Phone: 267-737-8484