Active NPI
Charlo M Jatta, PHARMACIST
- Pharmacist
- Mullens, WV
National Provider Identifier
1164715694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP0004597
- Practice address
- 401 Moran Ave
Mullens, WV 25882-1430 - Phone
- (304) 294-0343
- Fax
- (304) 294-7503
- NPI assigned
- May 17, 2011
- Sex
- Male
- Sole proprietor
- No
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 | RP0004597 | WV | Primary |
Addresses
Primary practice location
401 Moran Ave
Mullens, WV 25882-1430
Mailing address
1191 Stewart St
1191 Stewart Street
Welch, WV 24801-2133
Phone (304) 436-4938
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP0004597 | WV | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305590400000",
"number": "1164715694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1191 STEWART ST",
"address_2": "1191 STEWART STREET",
"city": "WELCH",
"state": "WV",
"postal_code": "248012133",
"telephone_number": "304-436-4938",
"fax_number": "304-294-7503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 MORAN AVE",
"city": "MULLENS",
"state": "WV",
"postal_code": "258821430",
"telephone_number": "304-294-0343",
"fax_number": "304-294-7503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JATTA",
"first_name": "CHARLO",
"middle_name": "M",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-17",
"last_updated": "2011-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0004597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mullens, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.