Provider Demographics
NPI:1003084070
Name:GORLE, RADHAKRISHNA
Entity type:Individual
Prefix:
First Name:RADHAKRISHNA
Middle Name:
Last Name:GORLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 BELLE RIVE BLVD APT 108
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9516
Mailing Address - Country:US
Mailing Address - Phone:405-326-8689
Mailing Address - Fax:
Practice Address - Street 1:8560 ARGYLE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5997
Practice Address - Country:US
Practice Address - Phone:904-779-7700
Practice Address - Fax:904-777-3054
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS43364OtherFLORIDA BOARD OF PHARMACY