Organization
GIRIRAJ LLC
Active
Other names
Lakewales Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GOPIKA TRIVEDI (OWNER)
(863) 676-0400
Entity
Organization
Contact information
Practice address
1322 STATE ROAD 60 E, LAKE WALES, FL 33853-4322
(863) 676-0400
(863) 676-0445
Mailing address
1322 STAE RD 60 E, LAKEWALES, FL 33853
(863) 676-0400
(863) 676-0445
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26509
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137946
PK
—
Enumeration date
11/20/2012
Last updated
02/21/2017
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