MEDICARE: SANJIVANI 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	008264	GA

Other Identifiers

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

General Provider Information

NPI Number	:	1952358822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANJIVANI INC.

Provider Business Mailing Address
First Line	:	712 DALLAS HWY
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1203
Country	:	US
Telephone Number	:	770-459-9499
Fax Number	:	770-459-9803

Provider Business Practice Location Address
First Line	:	712 DALLAS HWY
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1203
Country	:	US
Telephone Number	:	770-459-9499
Fax Number	:	770-459-9803

Authorized Official
Title or Position	:	CHIEF PHARMACIST OWNER
Name	:	MR. PARIKSHIT S PATEL
Credential	:	RPH.
Telephone Number	:	770-459-9499

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/18/2013

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