Active NPI
Mallory Kruckman, PHARM.D., RPH
- Pharmacist
- Jeffersonville, IN
National Provider Identifier
1942582291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26023808A
- Practice address
- 2811 Holmans LN
Jeffersonville, IN 47130-5915 - Phone
- (812) 288-9287
- NPI assigned
- Sep 13, 2011
- Sex
- Female
- 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 | 26023808A | IN | Primary |
Addresses
Primary practice location
2811 Holmans LN
Jeffersonville, IN 47130-5915
Mailing address
9724 Timberbrook Dr
Louisville, KY 40223-3507
Phone (847) 691-1727
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
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26023808A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315872000000",
"number": "1942582291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9724 TIMBERBROOK DR",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402233507",
"telephone_number": "847-691-1727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2811 HOLMANS LN",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471305915",
"telephone_number": "812-288-9287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUCKMAN",
"first_name": "MALLORY",
"name_prefix": "Dr.",
"credential": "PHARM.D., RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-13",
"last_updated": "2011-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26023808A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jeffersonville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.