Provider Demographics
NPI:1780996587
Name:LOKULA, VENKAT N
Entity type:Individual
Prefix:
First Name:VENKAT
Middle Name:N
Last Name:LOKULA
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 1:9 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345
Mailing Address - Country:US
Mailing Address - Phone:207-582-3051
Mailing Address - Fax:207-582-0418
Practice Address - Street 1:9 SPRING ST
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-1823
Practice Address - Country:US
Practice Address - Phone:207-582-3051
Practice Address - Fax:207-582-0418
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist