Healthcare Provider Details

I. General information

NPI: 1356418503
Provider Name (Legal Business Name): GOODLUCK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15320 NW GAINESVILLE RD
REDDICK FL
32686
US

IV. Provider business mailing address

PO BOX 215
REDDICK FL
32686-0215
US

V. Phone/Fax

Practice location:
  • Phone: 352-591-1116
  • Fax: 352-591-3003
Mailing address:
  • Phone: 352-361-3878
  • Fax: 352-591-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23223
License Number StateFL

VIII. Authorized Official

Name: MAHESH PATEL
Title or Position: OWNER
Credential:
Phone: 352-361-3878