MEDICARE: PARAM SANTOSH 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	3336C0003X	Community/Retail Pharmacy	02-2549350	OH

General Provider Information

NPI Number	:	1609246081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAM SANTOSH LLC

Provider Business Mailing Address
First Line	:	3114 CLARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1146
Country	:	US
Telephone Number	:	216-651-5700
Fax Number	:	216-744-2594

Provider Business Practice Location Address
First Line	:	3114 CLARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1146
Country	:	US
Telephone Number	:	216-651-5700
Fax Number	:	216-744-2594

Authorized Official
Title or Position	:	OWNER
Name	:	CHETAN PATEL
Credential	:
Telephone Number	:	216-651-5700

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	07/06/2016

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Directions to “PARAM SANTOSH LLC ” Practice Location

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