Provider Demographics
NPI:1861081093
Name:JAY SHIV SHANKAR LLC
Entity type:Organization
Organization Name:JAY SHIV SHANKAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARDIKKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-788-8879
Mailing Address - Street 1:416 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-4813
Mailing Address - Country:US
Mailing Address - Phone:215-788-8879
Mailing Address - Fax:215-788-8890
Practice Address - Street 1:416 MILL ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-4813
Practice Address - Country:US
Practice Address - Phone:215-788-8879
Practice Address - Fax:215-788-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy