Provider Demographics
NPI:1801879291
Name:ASR HEALTH INC.
Entity type:Organization
Organization Name:ASR HEALTH INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KANDRU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-962-1200
Mailing Address - Street 1:12677 HESPERIA RD STE 180
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7754
Mailing Address - Country:US
Mailing Address - Phone:760-962-1200
Mailing Address - Fax:760-962-1222
Practice Address - Street 1:12677 HESPERIA ROAD
Practice Address - Street 2:SUITE 180
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-962-1200
Practice Address - Fax:760-962-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57281Medicaid
CAPHA455330Medicaid