MEDICARE: SHIVAM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH24278	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1049166	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1043545064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIVAM LLC

Provider Business Mailing Address
First Line	:	1280 N MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6015
Country	:	US
Telephone Number	:	561-249-1524
Fax Number	:	561-249-1526

Provider Business Practice Location Address
First Line	:	1280 N MILITARY TRL
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6015
Country	:	US
Telephone Number	:	561-249-1524
Fax Number	:	561-249-1526

Authorized Official
Title or Position	:	OWNER
Name	:	BHARAT KANANI
Credential	:	RPH
Telephone Number	:	561-601-8680

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	01/31/2010

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Directions to “SHIVAM LLC ” Practice Location

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