Provider Demographics
NPI:1174815237
Name:SHREE LAXMI LLC
Entity type:Organization
Organization Name:SHREE LAXMI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARTH
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-823-2222
Mailing Address - Street 1:8 S MAIN ST
Mailing Address - Street 2:STE B
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1565
Mailing Address - Country:US
Mailing Address - Phone:715-823-2106
Mailing Address - Fax:715-823-1322
Practice Address - Street 1:8 S MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1565
Practice Address - Country:US
Practice Address - Phone:715-823-2222
Practice Address - Fax:715-823-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1000279719Medicaid
2130012OtherPK