1326021833 NPI number — RADHIKA CORP

Table of content: (NPI 1326021833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326021833 NPI number — RADHIKA CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADHIKA CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GROVELAND PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326021833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 E BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34736-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-429-1353
Provider Business Mailing Address Fax Number:
352-429-1383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 E BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34736-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-429-1353
Provider Business Practice Location Address Fax Number:
352-429-1383
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
DUSHYANT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
352-429-1353

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH21322 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030845500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004561 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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