Healthcare Provider Details

I. General information

NPI: 1154674968
Provider Name (Legal Business Name): DHANALAKSHMI RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 NW 62ND ST
MIAMI FL
33150-4329
US

IV. Provider business mailing address

659 NW 62ND ST
MIAMI FL
33150-4329
US

V. Phone/Fax

Practice location:
  • Phone: 305-759-3339
  • Fax: 305-759-6335
Mailing address:
  • Phone: 305-759-3339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH26427
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26427
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH26427
License Number StateFL

VIII. Authorized Official

Name: RAM PRASAD CHOUDHURY
Title or Position: MANAGER
Credential:
Phone: 941-752-4302