Provider Demographics
NPI:1871535641
Name:SRI ANJANEYA LLC
Entity type:Organization
Organization Name:SRI ANJANEYA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:UMAMAHESWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRIPURAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-572-1118
Mailing Address - Street 1:241 N KESWICK AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:241 N KESWICK AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4803
Practice Address - Country:US
Practice Address - Phone:215-572-1118
Practice Address - Fax:215-572-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4814793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3985213OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3985213OtherOTHER ID NUMBER