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General NPI Number Information
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NPI Number | 1407076664
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Entity Type | Individual
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Provider Name | NAGARAJU TUMMALA R.PH.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6060 FORT CAROLINE RD STE 10
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City | JACKSONVILLE
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State | FL
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Zip | 32277-1890
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Country | US
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Telephone | 904-745-0808
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Fax | 904-745-1155
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Provider Business Mailing Address
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Address Line | 3515 LAUREL MILL DR
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City | ORANGEPARK
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State | FL
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Zip | 32065
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Country | US
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Telephone | 904-207-0355
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Fax | 904-745-1155
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS0037084
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License Number State | FL
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