Provider Demographics
NPI:1699112284
Name:THIRUMALA GROUP LLC
Entity type:Organization
Organization Name:THIRUMALA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADI
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:972-736-3777
Mailing Address - Street 1:100 W PRINCETON DR # A
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407
Mailing Address - Country:US
Mailing Address - Phone:972-736-3777
Mailing Address - Fax:972-736-3773
Practice Address - Street 1:100 W PRINCETON DR # A
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-9607
Practice Address - Country:US
Practice Address - Phone:972-736-3777
Practice Address - Fax:972-736-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX284963336C0003X, 3336C0003X
3336L0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140463OtherPK