Active NPI
Chacko Joseph Puthentharayil, B.PHARM
- Pharmacist
- Olivet, MI
National Provider Identifier
1376772129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302035928
- Practice address
- 116 N. Main Street
Olivet Pharmacy
Olivet, MI 49076 - Phone
- (692) 805-0052
- NPI assigned
- Jul 14, 2009
- Last updated
- Jun 8, 2020
- 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 | 5302035928 | MI | Primary |
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
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 |
|---|---|---|---|
| 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 |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Retail Pharmacy
- Almont, MI
- NPI 1316639958
-
dba Healthwatch pharmacy
- Community/Retail Pharmacy
- Lake Orion, MI
- NPI 1881292001
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591574400000",
"number": "1376772129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "56507 KEN CHARLES DR",
"city": "SHELBY TOWNSHIP",
"state": "MI",
"postal_code": "483166108",
"telephone_number": "489-467-7252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 N. MAIN STREET",
"address_2": "OLIVET PHARMACY",
"city": "OLIVET",
"state": "MI",
"postal_code": "49076",
"telephone_number": "692-805-0052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTHENTHARAYIL",
"first_name": "CHACKO",
"middle_name": "JOSEPH",
"name_prefix": "Mr.",
"credential": "B.PHARM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-14",
"last_updated": "2020-06-08",
"certification_date": "2020-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302035928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olivet, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.