Provider Demographics
NPI:1730404401
Name:GOPALAKRISHNAN, SHIMI (PHARMD)
Entity type:Individual
Prefix:
First Name:SHIMI
Middle Name:
Last Name:GOPALAKRISHNAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4620
Mailing Address - Country:US
Mailing Address - Phone:516-633-9877
Mailing Address - Fax:
Practice Address - Street 1:812 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4620
Practice Address - Country:US
Practice Address - Phone:516-633-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 054309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist