Provider Demographics
NPI:1134406234
Name:LAKSHMINARAYANAN, BALAJI (BPHARM)
Entity type:Individual
Prefix:MR
First Name:BALAJI
Middle Name:
Last Name:LAKSHMINARAYANAN
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13221 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2163
Mailing Address - Country:US
Mailing Address - Phone:941-426-1123
Mailing Address - Fax:941-423-2827
Practice Address - Street 1:13221 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2163
Practice Address - Country:US
Practice Address - Phone:941-426-1123
Practice Address - Fax:941-423-2827
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist