Provider Demographics
NPI:1023355641
Name:JAKKA, KRISHNA KUMAR NAGA VENKATA (RPH)
Entity type:Individual
Prefix:
First Name:KRISHNA KUMAR
Middle Name:NAGA VENKATA
Last Name:JAKKA
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 1:1201 WOODLANDHILLS DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611
Mailing Address - Country:US
Mailing Address - Phone:904-314-2276
Mailing Address - Fax:203-549-0650
Practice Address - Street 1:130 GOVERNOR TRUMBULL WAY
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5603
Practice Address - Country:US
Practice Address - Phone:904-314-2276
Practice Address - Fax:203-590-3738
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056726-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28R03209900OtherPHARMACIST
FLPS41668OtherPHARMACIST
NY056726-1OtherPHARMACIST
CTPCT.0010976OtherPHARMACIST