Provider Demographics
NPI:1225298367
Name:INAPURI, KRISHNA KISHORE (RPH)
Entity Type:Individual
Prefix:MR
First Name:KRISHNA
Middle Name:KISHORE
Last Name:INAPURI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 STAATS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2351
Mailing Address - Country:US
Mailing Address - Phone:443-527-0857
Mailing Address - Fax:
Practice Address - Street 1:828 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4403
Practice Address - Country:US
Practice Address - Phone:718-493-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000190-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03013018Medicaid