Provider Demographics
NPI:1447513395
Name:NUKALA, GOKUL (RPH)
Entity type:Individual
Prefix:
First Name:GOKUL
Middle Name:
Last Name:NUKALA
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 1:200 S TEEL DR
Mailing Address - Street 2:
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-3210
Mailing Address - Country:US
Mailing Address - Phone:830-455-5071
Mailing Address - Fax:830-455-5073
Practice Address - Street 1:200 S TEEL DR
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-3210
Practice Address - Country:US
Practice Address - Phone:830-455-5071
Practice Address - Fax:830-455-5073
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56175183500000X
WAPH00067037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist