=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346633245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRISHNA HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2015
-----------------------------------------------------
Last Update Date | 03/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5751 BENEVA RD
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-960-2549
-----------------------------------------------------
Fax | 941-960-2579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5751 BENEVA RD
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-960-2549
-----------------------------------------------------
Fax | 941-960-2579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | MR. NITINKUMAR PARSHOTAMBHAI PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-960-2549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH28781
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------