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General NPI Number Information
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NPI Number | 1003084070
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Entity Type | Individual
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Provider Name | RADHAKRISHNA GORLE
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Gender | Male
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 8560 ARGYLE FOREST BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32244-5997
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Country | US
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Telephone | 904-779-7700
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Fax | 904-777-3054
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Provider Business Mailing Address
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Address Line | 10010 BELLE RIVE BLVD APT 108
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9516
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Country | US
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Telephone | 405-326-8689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS43364
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License Number State | FL
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