Healthcare Provider Details

I. General information

NPI: 1003142795
Provider Name (Legal Business Name): UMA LAKSHMI GUDURU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 LAKEVIEW PKWY
ROWLETT TX
75088-4532
US

IV. Provider business mailing address

8801 LAKEVIEW PKWY
ROWLETT TX
75088-4532
US

V. Phone/Fax

Practice location:
  • Phone: 972-463-8224
  • Fax:
Mailing address:
  • Phone: 972-463-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47205
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: