Provider Demographics
NPI:1538576152
Name:KRISHNA HEALTHMEDS LLC
Entity type:Organization
Organization Name:KRISHNA HEALTHMEDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:JHALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-818-9710
Mailing Address - Street 1:4885 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2577
Mailing Address - Country:US
Mailing Address - Phone:636-244-5385
Mailing Address - Fax:
Practice Address - Street 1:4885 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2577
Practice Address - Country:US
Practice Address - Phone:636-244-5385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140239573336C0004X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy