=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467939884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHREEJI HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2018
-----------------------------------------------------
Last Update Date | 07/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11441 HEACOCK ST
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92557-7907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-360-8352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1113 ALTA AVE STE 100
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91786-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-360-8352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | JINESH PATEL
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 714-270-7432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------