MEDICARE: SRI RX 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PCY.0002208	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2142702	OTHER		PK

General Provider Information

NPI Number	:	1396172524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRI RX LLC

Provider Business Mailing Address
First Line	:	140 GREENWOOD AVE
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2530
Country	:	US
Telephone Number	:	203-792-3363
Fax Number	:	203-792-3364

Provider Business Practice Location Address
First Line	:	140 GREENWOOD AVE
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2530
Country	:	US
Telephone Number	:	203-792-3363
Fax Number	:	203-792-3364

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SRIKANTH POPURI
Credential	:
Telephone Number	:	717-779-3036

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	12/05/2016

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Directions to “SRI RX LLC ” Practice Location

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