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General NPI Number Information
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NPI Number | 1396817185
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Entity Type | Organization
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Legal Business Name | SAI RX MART LLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 663 E CEDAR AVE
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City | GLADWIN
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State | MI
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Zip | 48624-2215
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Country | US
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Telephone | 989-426-4595
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Fax | 989-426-1993
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Provider Business Mailing Address
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Address Line | 663 E CEDAR AVE
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City | GLADWIN
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State | MI
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Zip | 48624-2215
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Country | US
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Telephone | 989-426-4595
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Fax | 989-426-1993
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Authorized Official
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Title or Position | MANAGER
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Name | SIVA JONNALGADA
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Credential |
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Telephone | 732-494-0458
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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 | 5301010088
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License Number State | MI
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