MEDICARE: DIKSHA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PH 21404	FL
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568462380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIKSHA INC

Provider Business Mailing Address
First Line	:	530 N WASHINGTON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2735
Country	:	US
Telephone Number	:	941-475-5636
Fax Number	:	941-474-7993

Provider Business Practice Location Address
First Line	:	530 N WASHINGTON ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-2735
Country	:	US
Telephone Number	:	941-475-5636
Fax Number	:	941-474-7993

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD KOOCH
Credential	:
Telephone Number	:	941-475-5636

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	10/19/2023

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Directions to “DIKSHA INC ” Practice Location

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