Active NPI
Jake N Chulla
- Pharmacist
- Jacksonville, FL
National Provider Identifier
1477102192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS62872
- Practice address
- 5858 Atlantic Blvd
Jacksonville, FL 32207-2223 - Phone
- (904) 721-3410
- NPI assigned
- Sep 5, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS62872 | FL | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | PSI38313 | FL |
Addresses
Primary practice location
5858 Atlantic Blvd
Jacksonville, FL 32207-2223
Mailing address
9823 Tapestry Park Cir Unit 503
Jacksonville, FL 32246-9239
Phone (727) 953-0750
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 |
|---|---|---|---|
| PS62872 | FL | MD | Pharmacist |
| PSI38313 | FL | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628467200000",
"number": "1477102192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9823 TAPESTRY PARK CIR UNIT 503",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322469239",
"telephone_number": "727-953-0750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5858 ATLANTIC BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322072223",
"telephone_number": "904-721-3410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHULLA",
"first_name": "JAKE",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-05",
"last_updated": "2021-08-09",
"certification_date": "2021-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS62872",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "FL",
"license": "PSI38313",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.