Healthcare Provider Details

I. General information

NPI: 1780996587
Provider Name (Legal Business Name): VENKAT N LOKULA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SPRING ST
GARDINER ME
04345-1823
US

IV. Provider business mailing address

9 SPRING ST
GARDINER ME
04345
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-3051
  • Fax: 207-582-0418
Mailing address:
  • Phone: 207-582-3051
  • Fax: 207-582-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5214
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: