Organization
SHREE KESRINANDAN LLC
Active
Other names
athens pharmacy, ATHENS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KETAN TRIVEDI (MEMBER)
(678) 205-7038
Entity
Organization
Contact information
Practice address
1086 BAXTER ST, ATHENS, GA 30606-6316
(706) 850-5553
(706) 850-7557
Mailing address
1086 BAXTER ST, ATHENS, GA 30606-6316
(706) 850-5553
(706) 850-7557
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010406
GA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003198628A
—
GA
01
—
2171044
PK
—
Enumeration date
08/18/2017
Last updated
04/18/2018
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