Provider Demographics
NPI:1497078943
Name:MALLA, TULASI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TULASI
Middle Name:
Last Name:MALLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989
Mailing Address - Country:US
Mailing Address - Phone:845-268-4765
Mailing Address - Fax:
Practice Address - Street 1:33 ROUTE 303
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989
Practice Address - Country:US
Practice Address - Phone:845-268-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist