Provider Demographics
NPI:1326021833
Name:RADHIKA CORP
Entity Type:Organization
Organization Name:RADHIKA CORP
Other - Org Name:GROVELAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DUSHYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-429-1353
Mailing Address - Street 1:145 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-2501
Mailing Address - Country:US
Mailing Address - Phone:352-429-1353
Mailing Address - Fax:352-429-1383
Practice Address - Street 1:145 E BROAD ST
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-2501
Practice Address - Country:US
Practice Address - Phone:352-429-1353
Practice Address - Fax:352-429-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH213223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030845500Medicaid
2004561OtherPK
5343810002Medicare NSC