Jayakrishna Uppoor Kukkillaya, BPHARM

Key facts

NPI

1346842077

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

RP0006757 (WV)

Practice address

2700 Mountaineer Blvd
South Charleston, WV 25309-9446

Phone

(304) 766-1725

Fax

(304) 746-1727

NPI assigned

Nov 9, 2020

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 9, 2020.

{
    "created_epoch": "1604880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604880000000",
    "number": "1346842077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 MOUNTAINEER BLVD",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253099446",
            "telephone_number": "304-766-1725",
            "fax_number": "304-746-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 MOUNTAINEER BLVD",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253099446",
            "telephone_number": "304-766-1725",
            "fax_number": "304-746-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUKKILLAYA",
        "first_name": "JAYAKRISHNA",
        "middle_name": "UPPOOR",
        "name_prefix": "Mr.",
        "credential": "BPHARM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-09",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WV",
            "license": "RP0006757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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