=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770981136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHRI MALAXMI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2014
-----------------------------------------------------
Last Update Date | 01/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 NORTON RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-465-7070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 NORTON RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-1711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-465-7070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | MR. DIVYESH PATEL
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 614-465-7070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 022459900
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------