Healthcare Provider Details

I. General information

NPI: 1649683467
Provider Name (Legal Business Name): UMA SHYAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 5TH ST
READING PA
19601-3497
US

IV. Provider business mailing address

1420 LEHMAN CT
ANNAPOLIS MD
21409-5483
US

V. Phone/Fax

Practice location:
  • Phone: 443-603-9918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP482496
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YAGNESH PATEL
Title or Position: PHARMACY MANAGER
Credential: RPH.
Phone: 732-986-0093