Organization
SRISAI RX MART LLC
Active
Other names
sanford family pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SIVA JONNALGADA (MANAGER)
(732) 494-0458
Entity
Organization
Contact information
Practice address
28 W SAGINAW RD, SANFORD, MI 48657-9206
(989) 687-2612
(989) 687-5596
Mailing address
28 W SAGINAW RD, SANFORD, MI 48657-9206
(989) 687-2612
(989) 687-5596
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301010291
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143276
PK
—
Enumeration date
02/27/2007
Last updated
04/09/2014
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