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General NPI Number Information
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NPI Number | 1699112284
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Entity Type | Organization
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Legal Business Name | THIRUMALA GROUP LLC
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 100 W PRINCETON DR # A
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City | PRINCETON
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State | TX
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Zip | 75407-9607
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Country | US
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Telephone | 972-736-3777
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Fax | 972-736-3773
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Provider Business Mailing Address
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Address Line | 100 W PRINCETON DR # A
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City | PRINCETON
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State | TX
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Zip | 75407
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Country | US
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Telephone | 972-736-3777
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Fax | 972-736-3773
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Authorized Official
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Title or Position | CEO
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Name | ADI GELLI
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Credential | RPH
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Telephone | 972-736-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 28496
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License Number State | TX
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