Provider Demographics
NPI:1740526680
Name:KOMMINENI, LAKSHMI RAMESH
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:RAMESH
Last Name:KOMMINENI
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 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2028
Mailing Address - Country:US
Mailing Address - Phone:610-584-6400
Mailing Address - Fax:
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2028
Practice Address - Country:US
Practice Address - Phone:267-737-8484
Practice Address - Fax:267-737-8664
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03495600183500000X
PARP447181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist