Organization
JAY SHREE GANESH INC
Active
Other names
DUPONT DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
BHARAT PATEL (OWNER)
(260) 445-6741
Entity
Organization
Contact information
Practice address
10124 AUBURN PARK DR, FORT WAYNE, IN 46825-2392
(260) 739-7160
(260) 739-7268
Mailing address
10124 AUBURN PARK DR, FORT WAYNE, IN 46825-2392
(260) 445-6741
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60006305A
IN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1563851
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/18/2012
Last updated
08/31/2012
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