Provider Demographics
NPI:1871595975
Name:SHRI HARI PHARMACY LLC
Entity type:Organization
Organization Name:SHRI HARI PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO- PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHETEMKUMAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-456-5450
Mailing Address - Street 1:3114 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109
Mailing Address - Country:US
Mailing Address - Phone:216-651-5700
Mailing Address - Fax:724-567-7185
Practice Address - Street 1:114 GRANT AVE
Practice Address - Street 2:
Practice Address - City:VANDERGRIFT
Practice Address - State:PA
Practice Address - Zip Code:15690-1208
Practice Address - Country:US
Practice Address - Phone:724-568-1221
Practice Address - Fax:724-567-7185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412142L333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA071710401Medicaid
PA0144370001Medicaid
PA0144370001Medicare ID - Type Unspecified