Provider Demographics
NPI:1992371991
Name:GOSINE, SHAKTI
Entity Type:Individual
Prefix:
First Name:SHAKTI
Middle Name:
Last Name:GOSINE
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 1:2970 ST JOHN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8572
Mailing Address - Country:US
Mailing Address - Phone:954-652-1733
Mailing Address - Fax:
Practice Address - Street 1:2970 ST JOHN DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8572
Practice Address - Country:US
Practice Address - Phone:954-336-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist