MEDICARE: SRI POPURI

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	183500000X	Pharmacist	PCT.0011714	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PCT.0011714	OTHER	CT	PHARMACIST LIC

General Provider Information

NPI Number	:	1497266183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRI POPURI

Provider Business Mailing Address
First Line	:	140 GREENWOOD AVE
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2530
Country	:	US
Telephone Number	:	203-718-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 GREENWOOD AVE
Second Line	:
City	:	BETHEL
State	:	CT
Zip	:	06801-2530
Country	:	US
Telephone Number	:	203-718-0000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	10/20/2017

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Directions to “ SRI POPURI ” Practice Location

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