Organization
SAI RX MART LLC
Active
Other names
MILLERS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
TRIVIKRAM KANUMURI RPH (PIC, AO)
(718) 447-4127
Entity
Organization
Contact information
Practice address
173 BROAD ST, STATEN ISLAND, NY 10304-2057
(718) 447-4127
(718) 273-1232
Mailing address
173 BROAD ST, STATEN ISLAND, NY 10304-2057
(718) 447-4127
(718) 273-1232
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
035081
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04680228
—
NY
01
—
2167918
PK
—
Enumeration date
10/19/2016
Last updated
04/19/2018
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