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General NPI Number Information
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NPI Number | 1023355641
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Entity Type | Individual
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Provider Name | KRISHNA KUMAR NAGA VENKATA JAKKA RPH
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Gender | Male
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 130 GOVERNOR TRUMBULL WAY
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City | TRUMBULL
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State | CT
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Zip | 06611-5603
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Country | US
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Telephone | 904-314-2276
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Fax | 203-590-3738
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Provider Business Mailing Address
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Address Line | 1201 WOODLANDHILLS DR
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City | TRUMBULL
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State | CT
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Zip | 06611
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Country | US
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Telephone | 904-314-2276
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Fax | 203-549-0650
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 056726-1
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License Number State | NY
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