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General NPI Number Information
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NPI Number | 1356619365
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Entity Type | Organization
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Legal Business Name | SMITA BALAJI ENTERPRISE INC
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 980 N WALNUT CREEK DR STE 118
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City | MANSFIELD
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State | TX
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Zip | 76063-8020
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Country | US
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Telephone | 817-453-5700
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Fax | 817-453-5705
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Provider Business Mailing Address
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Address Line | 980 N WALNUT CREEK DR STE 118
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City | MANSFIELD
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State | TX
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Zip | 76063-8020
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Country | US
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Telephone | 817-453-5700
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Fax | 817-453-5705
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Authorized Official
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Title or Position | SECRETARY
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Name | KAMLESH KURANI
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Credential |
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Telephone | 817-690-1374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 27729
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License Number State | TX
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