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General NPI Number Information
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NPI Number | 1275821134
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Entity Type | Organization
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Legal Business Name | TIRUMALA PHARMACY INC
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Dates
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Enumeration Date | 07/13/2011
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 4106 W LAKE MARY BLVD STE 130
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City | LAKE MARY
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State | FL
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Zip | 32746-3383
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Country | US
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Telephone | 407-878-7615
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Fax | 407-878-7616
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Provider Business Mailing Address
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Address Line | 4106 W LAKE MARY BLVD #130
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City | LAKE MARY
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State | FL
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Zip | 32746-3315
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Country | US
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Telephone | 407-878-7615
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Fax | 407-878-7616
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Authorized Official
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Title or Position | DIRECTOR/PHARMACY MANAGER
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Name | MR. SIVARAMAKRISHNA KONDAPALLI
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Credential |
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Telephone | 407-878-7615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25563
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License Number State | FL
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