Provider Demographics
NPI:1932119674
Name:SHRI GOKUL DRUGS LLC
Entity Type:Organization
Organization Name:SHRI GOKUL DRUGS LLC
Other - Org Name:LAKES AREA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VENKATAKIRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-261-9694
Mailing Address - Street 1:608 BUCHANAN DR
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611
Mailing Address - Country:US
Mailing Address - Phone:512-756-8550
Mailing Address - Fax:512-756-7005
Practice Address - Street 1:608 BUCHANAN DR
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611
Practice Address - Country:US
Practice Address - Phone:512-756-8550
Practice Address - Fax:512-756-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX159713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144151Medicaid
TX149274Medicaid