Provider Demographics
NPI:1437384476
Name:VELISHALA, VIROOPAKSHA (BS)
Entity Type:Individual
Prefix:MR
First Name:VIROOPAKSHA
Middle Name:
Last Name:VELISHALA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N MACARTHUR BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3606
Mailing Address - Country:US
Mailing Address - Phone:972-889-9805
Mailing Address - Fax:972-483-5971
Practice Address - Street 1:3501 N MACARTHUR BLVD STE 340
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:972-889-9805
Practice Address - Fax:972-483-5971
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist