Healthcare Provider Details

I. General information

NPI: 1073170296
Provider Name (Legal Business Name): SHIVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 CHARDONNAY AVE STE 5
PROSSER WA
99350-9545
US

IV. Provider business mailing address

354 CHARDONNAY AVE STE 5
PROSSER WA
99350-9545
US

V. Phone/Fax

Practice location:
  • Phone: 509-788-0123
  • Fax: 509-788-0124
Mailing address:
  • Phone: 509-788-0123
  • Fax: 509-788-0124

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: UMESH GAJJALA
Title or Position: OWNER/MEMBER
Credential:
Phone: 509-631-1453