Provider Demographics
NPI:1326780313
Name:GOPALAN, LAKSHMI MENON (RPH)
Entity Type:Individual
Prefix:
First Name:LAKSHMI MENON
Middle Name:
Last Name:GOPALAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13636 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9374
Mailing Address - Country:US
Mailing Address - Phone:317-979-6096
Mailing Address - Fax:
Practice Address - Street 1:3950 BRODHEAD RD STE 330
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3030
Practice Address - Country:US
Practice Address - Phone:888-350-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14084-40183500000X
GARPH027800183500000X
IN26021371A183500000X
IL051293771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist