Active NPI
Thomas Thundiyil Idiculla, R.PH.
- Pharmacist
- Springfield, MA
National Provider Identifier
1376767343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26923
- Practice address
- 759 Chestnut St
Springfield, MA 01199-1001 - Phone
- (860) 716-5356
- NPI assigned
- Apr 12, 2007
- 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 | 26923 | MA | Primary |
Addresses
Primary practice location
759 Chestnut St
Springfield, MA 01199-1001
Mailing address
212 Sterling Dr
Newington, CT 06111-2262
Phone (860) 716-5356
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
| License | State | Type | Specialty |
|---|---|---|---|
| 26923 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239235200000",
"number": "1376767343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 STERLING DR",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "061112262",
"telephone_number": "860-716-5356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "759 CHESTNUT ST",
"city": "SPRINGFIELD",
"state": "MA",
"postal_code": "011991001",
"telephone_number": "860-716-5356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDICULLA",
"first_name": "THOMAS",
"middle_name": "THUNDIYIL",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-12",
"last_updated": "2009-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "26923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.