Provider Demographics
NPI:1417272857
Name:JAGARLAMUDI, UMAPATHI (R PH)
Entity Type:Individual
Prefix:MR
First Name:UMAPATHI
Middle Name:
Last Name:JAGARLAMUDI
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SUNNYVIEW OVAL
Mailing Address - Street 2:
Mailing Address - City:KEASBEY
Mailing Address - State:NJ
Mailing Address - Zip Code:08832-1014
Mailing Address - Country:US
Mailing Address - Phone:732-738-1764
Mailing Address - Fax:
Practice Address - Street 1:199 MAIN ST
Practice Address - Street 2:KEANSBURG PHARMACY
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1734
Practice Address - Country:US
Practice Address - Phone:732-787-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03341800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist