Organization
SHIVAM SAGAR CORPORATION
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
30 CANAL ST, FORT PLAIN, NY 13339-1101
(518) 993-3003
(518) 993-4354
Mailing address
30 CANAL ST, FORT PLAIN, NY 13339-1101
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
025075
NY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02187259
—
NY
01
—
3323235
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
12/01/2006
Last updated
03/07/2023
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