Organization
TIRUMALA PHARMACY INC
Active
Organization
TIRUMALA PHARMACY INC
Active
Other names
Medplex Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIVARAMAKRISHNA KONDAPALLI (DIRECTOR/PHARMACY MANAGER)
(407) 878-7615
Entity
Organization
Contact information
Practice address
4106 W LAKE MARY BLVD STE 130, LAKE MARY, FL 32746-3383
(407) 878-7615
(407) 878-7616
Mailing address
4106 W LAKE MARY BLVD, #130, LAKE MARY, FL 32746-3315
(407) 878-7615
(407) 878-7616
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH25563
FL
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5706582
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/13/2011
Last updated
10/30/2015
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