Chacko Joseph Puthentharayil, B.PHARM
Individual provider Active NPI Pharmacist · Olivet, MI
NPI 1376772129 · NPPES record last updated Jun 8, 2020
Key facts
- NPI
- 1376772129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302035928 (MI)
- Practice address
- 116 N. Main Street
Olivet Pharmacy
Olivet, MI 49076 - Phone
- (692) 805-0052
- NPI assigned
- Jul 14, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302035928 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Almont Pharmacy LLC | Current | Accepting new patients | |
| Healthwatch Pharmacy Inc | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302035928 | MI | Yes |
Addresses
Primary practice location
116 N. Main Street
Olivet Pharmacy
Olivet, MI 49076
Mailing address
56507 Ken Charles Dr
Shelby Township, MI 48316-6108
Phone (489) 467-7252
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5302035928 | Other | MI | PHARMACIST |
Other providers in Olivet, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.