Provider Demographics
NPI:1063935054
Name:VENKATACHALA ADIGA, DEEPALAKSHMI
Entity type:Individual
Prefix:
First Name:DEEPALAKSHMI
Middle Name:
Last Name:VENKATACHALA ADIGA
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 1:10 COBBLERS CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823-1737
Mailing Address - Country:US
Mailing Address - Phone:732-343-5385
Mailing Address - Fax:
Practice Address - Street 1:10 COBBLERS CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1737
Practice Address - Country:US
Practice Address - Phone:732-343-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03047100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist