Provider Demographics
NPI:1144510975
Name:JASTI, PULLARAO
Entity type:Individual
Prefix:
First Name:PULLARAO
Middle Name:
Last Name:JASTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-4314
Mailing Address - Country:US
Mailing Address - Phone:609-937-8641
Mailing Address - Fax:
Practice Address - Street 1:850 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5170
Practice Address - Country:US
Practice Address - Phone:212-678-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055272-1183500000X
NJ28RI03172200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist