Provider Demographics
NPI:1356945430
Name:CHICKAKURAGODU, PRAKASH R (RPH)
Entity type:Individual
Prefix:
First Name:PRAKASH
Middle Name:R
Last Name:CHICKAKURAGODU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0807
Mailing Address - Country:US
Mailing Address - Phone:352-237-6206
Mailing Address - Fax:352-237-9571
Practice Address - Street 1:2401 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0807
Practice Address - Country:US
Practice Address - Phone:352-237-6206
Practice Address - Fax:352-237-9571
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist