Provider Demographics
NPI:1235381443
Name:THOOMPALLY, SRINATH
Entity Type:Individual
Prefix:MR
First Name:SRINATH
Middle Name:
Last Name:THOOMPALLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E ECKERSON ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-425-1131
Mailing Address - Fax:845-425-8035
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-425-1131
Practice Address - Fax:845-425-8035
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist