MEDICARE: KRISHNA HEALTHMEDS 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	2014023957	MO
2	333600000X	Pharmacy	2014023957	MO
3	3336C0003X	Community/Retail Pharmacy	2014023957	MO

General Provider Information

NPI Number	:	1538576152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISHNA HEALTHMEDS LLC

Provider Business Mailing Address
First Line	:	4885 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2577
Country	:	US
Telephone Number	:	636-244-5385
Fax Number	:

Provider Business Practice Location Address
First Line	:	4885 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2577
Country	:	US
Telephone Number	:	636-244-5385
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	RAJ JHALA
Credential	:
Telephone Number	:	951-818-9710

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	05/07/2015

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Directions to “KRISHNA HEALTHMEDS LLC ” Practice Location

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