Active NPI
Krishna Vanganur
- Pharmacist
- Clinton Township, MI
National Provider Identifier
1194000448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302036743
- Practice address
- 1045 S Gratiot Ave
Clinton Township, MI 48036-3501 - Phone
- (586) 954-4905
- NPI assigned
- Oct 19, 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 | 5302036743 | MI | Primary |
Addresses
Primary practice location
1045 S Gratiot Ave
Clinton Township, MI 48036-3501
Mailing address
4278 Sharon Ave
Windsor, ONTARIO N9G2X8
CA
Phone (519) 948-7375
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 |
|---|---|---|---|
| 5302036743 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318982400000",
"number": "1194000448",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "4278 SHARON AVE",
"city": "WINDSOR",
"state": "ONTARIO",
"postal_code": "N9G2X8",
"telephone_number": "519-948-7375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 S GRATIOT AVE",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480363501",
"telephone_number": "586-954-4905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANGANUR",
"first_name": "KRISHNA",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-19",
"last_updated": "2011-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302036743",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.