=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073149514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHRI HARI RX INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2020
-----------------------------------------------------
Last Update Date | 03/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2079 COMPTON AVE STE 105
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92881-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-365-3434
-----------------------------------------------------
Fax | 951-905-1609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15823 AVIATION CT
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91708-7617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-365-3434
-----------------------------------------------------
Fax | 951-905-1609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. TAPAN RAMESHCHANDRA PATEL
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 513-442-8078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------