Provider Demographics
NPI:1114369501
Name:LAKOJI, SURYA PRASAD
Entity Type:Individual
Prefix:MR
First Name:SURYA
Middle Name:PRASAD
Last Name:LAKOJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3730
Mailing Address - Country:US
Mailing Address - Phone:203-776-7100
Mailing Address - Fax:203-776-7102
Practice Address - Street 1:306 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3730
Practice Address - Country:US
Practice Address - Phone:203-776-7100
Practice Address - Fax:203-776-7102
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012228183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist