Organization
SRISIRI PHARMA INC
Active
Other names
Index park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KHAJENDRANATH ATLURI (AGENT)
(248) 953-2331
Entity
Organization
Contact information
Practice address
2255 FORT ST, INDEX PARK PHARMACY, LINCOLN PARK, MI 48146-2671
(313) 357-7500
(313) 347-8998
Mailing address
190 HADSELL DR, BLOOMFIELD HILLS, MI 48302-0408
(248) 953-2331
(313) 447-1688
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301010202
MI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2378405
NCPDP
MI
Enumeration date
09/30/2013
Last updated
09/25/2019
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