Provider Demographics
NPI:1689553810
Name:GUMUDAVELLI, POOJA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:POOJA
Middle Name:
Last Name:GUMUDAVELLI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 KADY LN
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1471
Mailing Address - Country:US
Mailing Address - Phone:208-409-2615
Mailing Address - Fax:
Practice Address - Street 1:72 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8203
Practice Address - Country:US
Practice Address - Phone:718-538-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist