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General NPI Number Information
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NPI Number | 1417005414
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Entity Type | Organization
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Legal Business Name | SIRI PHARMACY AND MEDICAL EQUIPMENT INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 31815 SOUTHFIELD RD MED VILLAGE STE 22
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5471
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Country | US
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Telephone | 248-203-0399
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Fax | 248-203-0388
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Provider Business Mailing Address
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Address Line | 2969 RIVER VALLEY DR
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City | TROY
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State | MI
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Zip | 48098-2394
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHCST
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Name | KHAJSNDRANTH ATLURI
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Credential |
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Telephone | 248-219-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 5301008565
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License Number State | MI
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