Active NPI
Pullaiah Kodumuru
- Pharmacist
- Miami, FL
National Provider Identifier
1922381342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS41125
- Practice address
- 1201 SW 1St St
Miami, FL 33135-2401 - Phone
- (305) 324-8193
- Fax
- (305) 324-8408
- NPI assigned
- Sep 21, 2011
- Last updated
- Mar 25, 2013
- 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 | PS41125 | FL | Primary |
| Pharmacist | 183500000X | 28RI03350400 | NJ |
Addresses
Primary practice location
1201 SW 1St St
Miami, FL 33135-2401
Mailing address
1201 SW 1St St
Miami, FL 33135-2401
Phone (786) 597-2829
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 |
|---|---|---|---|
| PS41125 | FL | MD | Pharmacist |
| 28RI03350400 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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": "1316563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364169600000",
"number": "1922381342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 SW 1ST ST",
"city": "MIAMI",
"state": "FL",
"postal_code": "331352401",
"telephone_number": "786-597-2829",
"fax_number": "305-324-8408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 SW 1ST ST",
"city": "MIAMI",
"state": "FL",
"postal_code": "331352401",
"telephone_number": "305-324-8193",
"fax_number": "305-324-8408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODUMURU",
"first_name": "PULLAIAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-21",
"last_updated": "2013-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS41125",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03350400",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.