MEDICARE: SHRI GANESH CORPORATION

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	3336C0003X	Community/Retail Pharmacy	PHY53433	CA

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

General Provider Information

NPI Number	:	1053426080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHRI GANESH CORPORATION

Provider Business Mailing Address
First Line	:	1942 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3908
Country	:	US
Telephone Number	:	562-591-0549
Fax Number	:	562-591-0540

Provider Business Practice Location Address
First Line	:	1942 E ANAHEIM ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3908
Country	:	US
Telephone Number	:	562-591-0549
Fax Number	:	562-591-0540

Authorized Official
Title or Position	:	OWNER, PIC
Name	:	CHIRAG PATEL
Credential	:	RPH
Telephone Number	:	562-591-0549

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	06/06/2016

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Directions to “SHRI GANESH CORPORATION ” Practice Location

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