MEDICARE: SREE GANESHA INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH29436	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2156108	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225494412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SREE GANESHA INC

Provider Business Mailing Address
First Line	:	3707 LAKE WORTH RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4033
Country	:	US
Telephone Number	:	740-707-3624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 LAKE WORTH RD
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4033
Country	:	US
Telephone Number	:	740-707-3624
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	SRIDHAR RANGAMANI
Credential	:
Telephone Number	:	740-707-3624

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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Directions to “SREE GANESHA INC ” Practice Location

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