Individual provider Active NPI

Sanjeeva Reddy Avuthu, RPH

  • Pharmacist
  • Corona, NY
National Provider Identifier
1144404336
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
048522 Issued in NY
Practice address
5822 99TH St
Corona, NY 11368-4306
Phone
(929) 463-3147
Fax
(929) 463-3148
NPI assigned
Dec 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 048522 NY Primary

Addresses

Primary practice location

5822 99TH St
Corona, NY 11368-4306

Mailing address

5822 99TH St
Corona, NY 11368-4306
Phone (929) 463-3147

Other identifiers 1

IdentifierTypeStateIssuer
048522OtherNYSTATE LICENSE

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
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
048522NYMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1144404336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5822 99TH ST",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113684306",
            "telephone_number": "929-463-3147",
            "fax_number": "929-463-3148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5822 99TH ST",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113684306",
            "telephone_number": "929-463-3147",
            "fax_number": "929-463-3148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVUTHU",
        "first_name": "SANJEEVA",
        "middle_name": "REDDY",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-24",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "048522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "048522",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.