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General NPI Number Information
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NPI Number | 1174981096
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Entity Type | Organization
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Legal Business Name | SRI SAI SANVI INTEGRATIVE PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 02/06/2016
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 1101 BLANDING BLVD STE 122
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City | ORANGE PARK
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State | FL
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Zip | 32065-6751
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Country | US
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Telephone | 904-644-8038
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Fax | 904-644-8671
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Provider Business Mailing Address
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Address Line | 3515 LAUREL MILL DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-5271
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Country | US
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Telephone | 904-644-8038
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Fax | 904-644-8671
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Authorized Official
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Title or Position | PHARMACY MANAGER/ OWNER / PIC/AO
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Name | NAGARAJU TUMMALA
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Credential |
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Telephone | 904-207-0355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH29483
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License Number State | FL
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