Organization
RAGHAVENDRA PHARMACY INC
Active
Other names
lakeside discount pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
NAGESH SHAKHAMOORI (VICE PRESIDENT)
(248) 631-6612
Entity
Organization
Contact information
Practice address
5431 N STATE ROAD 7, TAMARAC, FL 33319-2921
(954) 485-4903
(954) 485-4948
Mailing address
5431 N STATE ROAD 7, TAMARAC, FL 33319-2921
(954) 485-4903
(954) 485-4948
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH24727
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5700605
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/09/2010
Last updated
07/09/2010
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