Provider Demographics
NPI:1942981055
Name:ADIYOGI LLC
Entity type:Organization
Organization Name:ADIYOGI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRITAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:480-297-5589
Mailing Address - Street 1:1417 RIVERCHASE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2493
Mailing Address - Country:US
Mailing Address - Phone:803-970-6440
Mailing Address - Fax:803-970-6441
Practice Address - Street 1:1417 RIVERCHASE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2493
Practice Address - Country:US
Practice Address - Phone:803-970-6440
Practice Address - Fax:803-970-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy