Active NPI
Manjunath Medahalli Krishnappa
- Pharmacist
- North East, MD
National Provider Identifier
1063122489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18634
- Practice address
- 75 N East PLZ
North East, MD 21901-3617 - Phone
- (410) 287-3479
- NPI assigned
- Nov 28, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 18634 | MD | Primary |
Addresses
Primary practice location
75 N East PLZ
North East, MD 21901-3617
Mailing address
2405 Eastridge Rd
Lutherville, MD 21093-2509
Phone (410) 790-8914
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669593600000",
"number": "1063122489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2405 EASTRIDGE RD",
"city": "LUTHERVILLE",
"state": "MD",
"postal_code": "210932509",
"telephone_number": "410-790-8914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 N EAST PLZ",
"city": "NORTH EAST",
"state": "MD",
"postal_code": "219013617",
"telephone_number": "410-287-3479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISHNAPPA",
"first_name": "MANJUNATH",
"middle_name": "MEDAHALLI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-28",
"last_updated": "2022-11-28",
"certification_date": "2022-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "18634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North East, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.