Provider Demographics
NPI:1881044212
Name:THUMMA, LENINA
Entity Type:Individual
Prefix:
First Name:LENINA
Middle Name:
Last Name:THUMMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NANEL DR APT C
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2250
Mailing Address - Country:US
Mailing Address - Phone:646-912-1223
Mailing Address - Fax:
Practice Address - Street 1:26 NANEL DR APT C
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2250
Practice Address - Country:US
Practice Address - Phone:646-912-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060436OtherNY STATE BOARD OF PHARMACY