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General NPI Number Information
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NPI Number | 1932572294
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Entity Type | Organization
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Legal Business Name | SHIVASHIVAANI PHARMACY LLC
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 2703 JONES FRANKLIN RD SUITE 104
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City | CARY
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State | NC
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Zip | 27518-7171
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Country | US
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Telephone | 919-720-4109
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Fax | 919-703-0418
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Provider Business Mailing Address
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Address Line | 2703 JONES FRANKLIN RD SUITE 104
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City | CARY
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State | NC
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Zip | 27518-7171
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Country | US
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Telephone | 919-720-4109
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Fax | 919-703-0418
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Authorized Official
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Title or Position | OWNER
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Name | MR. RAVISANKARA R AVULA
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Credential | RPH
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Telephone | 919-720-4109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 12729
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License Number State | NC
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