Active NPI
Dhiraj Nukala Jr., R.PH
- Pharmacist
- Yuma, AZ
National Provider Identifier
1568873966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S016489
- Practice address
- 1555 S Avenue B
Yuma, AZ 85364-4584 - Phone
- (928) 819-0208
- Fax
- (928) 819-0599
- NPI assigned
- May 20, 2014
- Last updated
- May 20, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S016489 | AZ | Primary |
| Pharmacist | 183500000X | 0330003800 | VT |
Addresses
Primary practice location
1555 S Avenue B
Yuma, AZ 85364-4584
Mailing address
1334 S Avenue B
Apt 5
Yuma, AZ 85364-4350
Phone (928) 819-0208
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 |
|---|---|---|---|
| S016489 | AZ | MD | Pharmacist |
| 0330003800 | VT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arizona CVS Stores LLC | Past | Accepting new patients | |
| Arizona CVS Stores LLC | Past | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400544000000",
"number": "1568873966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1334 S AVENUE B",
"address_2": "APT 5",
"city": "YUMA",
"state": "AZ",
"postal_code": "853644350",
"telephone_number": "928-819-0208",
"fax_number": "928-810-0599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 S AVENUE B",
"city": "YUMA",
"state": "AZ",
"postal_code": "853644584",
"telephone_number": "928-819-0208",
"fax_number": "928-819-0599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUKALA",
"first_name": "DHIRAJ",
"name_suffix": "Jr.",
"credential": "R.PH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-20",
"last_updated": "2014-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S016489",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VT",
"license": "0330003800",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yuma, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.