Provider Demographics
NPI:1053637744
Name:THUMMALAPALLY, SIREESH KUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:SIREESH
Middle Name:KUMAR
Last Name:THUMMALAPALLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RECKLESSTOWN WAY
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08515-9768
Mailing Address - Country:US
Mailing Address - Phone:609-324-3515
Mailing Address - Fax:609-324-3515
Practice Address - Street 1:471 LENOX AVE
Practice Address - Street 2:LIFE PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3000
Practice Address - Country:US
Practice Address - Phone:212-694-5700
Practice Address - Fax:212-694-5794
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000172-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist