Individual provider Active NPI

Kamlesh Chudasama

  • Pharmacist
  • Dallas, TX
National Provider Identifier
1669072765
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
61113 Issued in TX
Practice address
15220 Montfort Rd
Dallas, TX 75248-6401
Phone
(972) 233-8764
NPI assigned
Oct 28, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 61113 TX Primary

Addresses

Primary practice location

15220 Montfort Rd
Dallas, TX 75248-6401

Mailing address

15220 Montfort Rd
Dallas, TX 75248-6401

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

LicenseStateTypeSpecialty
61113TXMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1669072765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15220 MONTFORT RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752486401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15220 MONTFORT RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752486401",
            "telephone_number": "972-233-8764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUDASAMA",
        "first_name": "KAMLESH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "61113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.

Verify at the official NPI Registry.