Healthcare Provider Details

I. General information

NPI: 1104752617
Provider Name (Legal Business Name): SHREE GANESH RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7474 GARNERS FERRY RD STE B
COLUMBIA SC
29209-2601
US

IV. Provider business mailing address

7474 GARNERS FERRY RD STE B
COLUMBIA SC
29209-2601
US

V. Phone/Fax

Practice location:
  • Phone: 803-567-1612
  • Fax:
Mailing address:
  • Phone: 803-567-1612
  • Fax:

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

VIII. Authorized Official

Name: MONANK PATEL
Title or Position: OWNER
Credential:
Phone: 803-567-1612