Provider Demographics
NPI:1184224305
Name:ALLA, LAKSHMI SEKHAR
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:SEKHAR
Last Name:ALLA
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 1:200 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2442
Mailing Address - Country:US
Mailing Address - Phone:508-393-1745
Mailing Address - Fax:508-393-1635
Practice Address - Street 1:200 OTIS ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2442
Practice Address - Country:US
Practice Address - Phone:508-393-1745
Practice Address - Fax:508-393-1635
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16197183500000X
MAPH25824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist