Provider Demographics
NPI:1558496257
Name:PERI, LAKSHMI
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:PERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 S CRANBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3015
Mailing Address - Country:US
Mailing Address - Phone:904-230-8125
Mailing Address - Fax:
Practice Address - Street 1:11101 SAINT AUGUSTINE RD
Practice Address - Street 2:WINN DIXIE 179
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1159
Practice Address - Country:US
Practice Address - Phone:904-260-9755
Practice Address - Fax:904-260-4385
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0040819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist