Provider Demographics
NPI:1568462380
Name:DIKSHA INC
Entity Type:Organization
Organization Name:DIKSHA INC
Other - Org Name:LEMON BAY DRUGS EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-475-5636
Mailing Address - Street 1:530 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-2735
Mailing Address - Country:US
Mailing Address - Phone:941-475-5636
Mailing Address - Fax:941-474-7993
Practice Address - Street 1:530 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-2735
Practice Address - Country:US
Practice Address - Phone:941-475-5636
Practice Address - Fax:941-474-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 21404333600000X
3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022771700Medicaid