Provider Demographics
NPI:1568092542
Name:GELLI, ADISESHU
Entity Type:Individual
Prefix:MR
First Name:ADISESHU
Middle Name:
Last Name:GELLI
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 1:721 W TARRANT RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-3445
Mailing Address - Country:US
Mailing Address - Phone:833-224-7223
Mailing Address - Fax:
Practice Address - Street 1:721 W TARRANT RD STE 110
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-3445
Practice Address - Country:US
Practice Address - Phone:833-224-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist