Provider Demographics
NPI:1437663747
Name:SHREEMAN PHARMACY INC
Entity type:Organization
Organization Name:SHREEMAN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:LAVANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-775-7775
Mailing Address - Street 1:1105 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4603
Mailing Address - Country:US
Mailing Address - Phone:516-775-7775
Mailing Address - Fax:516-775-7773
Practice Address - Street 1:1105 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4603
Practice Address - Country:US
Practice Address - Phone:516-775-7775
Practice Address - Fax:516-775-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0358933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2174301OtherPK