Provider Demographics
NPI:1780274019
Name:GOPALASAMY, THIRUMURUGAN (RPH)
Entity type:Individual
Prefix:
First Name:THIRUMURUGAN
Middle Name:
Last Name:GOPALASAMY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W TRENTON RD STE 12
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8023
Mailing Address - Country:US
Mailing Address - Phone:956-255-5515
Mailing Address - Fax:
Practice Address - Street 1:2500 W TRENTON RD STE 12
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8023
Practice Address - Country:US
Practice Address - Phone:956-255-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX49264OtherSTATE BOARD OF PHARMACY