Provider Demographics
NPI:1356418503
Name:GOODLUCK PHARMACY INC
Entity type:Organization
Organization Name:GOODLUCK PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-361-3878
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:FL
Mailing Address - Zip Code:32686-0215
Mailing Address - Country:US
Mailing Address - Phone:352-361-3878
Mailing Address - Fax:352-591-3003
Practice Address - Street 1:15320 NW GAINESVILLE RD
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686
Practice Address - Country:US
Practice Address - Phone:352-591-1116
Practice Address - Fax:352-591-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH232233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1046540OtherNCPDP PROVIDER IDENTIFICATION NUMBER