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General NPI Number Information
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NPI Number | 1104211382
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Entity Type | Organization
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Legal Business Name | JAI SHRI GANESH LLC
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 3317 SUNSET AVE
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City | OCEAN
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State | NJ
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Zip | 07712-4554
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Country | US
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Telephone | 732-775-3600
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Fax | 732-775-5603
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Provider Business Mailing Address
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Address Line | 3317 SUNSET AVE
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City | OCEAN
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State | NJ
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Zip | 07712-4554
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Country | US
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Telephone | 732-775-3600
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Fax | 732-775-5603
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Authorized Official
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Title or Position | PHARMACIST
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Name | VISHALKUMAR PATEL
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Credential |
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Telephone | 732-775-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28RS00371900
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License Number State | NJ
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