Provider Demographics
NPI:1568667152
Name:TUMMALA, VIJAYALAKSHMI
Entity type:Individual
Prefix:MRS
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:TUMMALA
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 1:1958 FALLEN LEAF LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-7206
Mailing Address - Country:US
Mailing Address - Phone:650-960-8591
Mailing Address - Fax:
Practice Address - Street 1:685 SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-1303
Practice Address - Country:US
Practice Address - Phone:650-948-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist