Provider Demographics
NPI:1407076664
Name:TUMMALA, NAGARAJU (RPH)
Entity Type:Individual
Prefix:
First Name:NAGARAJU
Middle Name:
Last Name:TUMMALA
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 1:3515 LAUREL MILL DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEPARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065
Mailing Address - Country:US
Mailing Address - Phone:904-207-0355
Mailing Address - Fax:904-745-1155
Practice Address - Street 1:6060 FORT CAROLINE RD STE 10
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1890
Practice Address - Country:US
Practice Address - Phone:904-745-0808
Practice Address - Fax:904-745-1155
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0037084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist