=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104980952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHREE PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 02/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5604 N BROAD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19141-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-927-0224
-----------------------------------------------------
Fax | 215-927-0813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5604 N BROAD ST PHARMACY
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19141-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-927-0224
-----------------------------------------------------
Fax | 215-927-0813
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHARMACIST IN CHARGE
-----------------------------------------------------
Name | MR. DARSHAN PAREKH
-----------------------------------------------------
Credential | PHARMD RPH
-----------------------------------------------------
Telephone | 215-284-4790
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------