Provider Demographics
NPI:1588203244
Name:KULKARNI, YOGESH SHANTARAM
Entity Type:Individual
Prefix:
First Name:YOGESH
Middle Name:SHANTARAM
Last Name:KULKARNI
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 1:4204 BROWNSBORO GLEN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-1197
Mailing Address - Country:US
Mailing Address - Phone:812-786-6415
Mailing Address - Fax:
Practice Address - Street 1:1265 GOSS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-2271
Practice Address - Country:US
Practice Address - Phone:502-634-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY013173OtherLICENSE NO.