=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215362298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BANSI CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2013
-----------------------------------------------------
Last Update Date | 03/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1657 EAST 6TH ST
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-769-3105
-----------------------------------------------------
Fax | 951-769-3496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1657 E 6TH ST
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92223-5765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-769-3105
-----------------------------------------------------
Fax | 951-769-3496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | ANANDKUMAR SHAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-255-0842
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 51586
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------