Provider Demographics
NPI:1902138241
Name:JASTI, KASINADH (BPHARM)
Entity Type:Individual
Prefix:
First Name:KASINADH
Middle Name:
Last Name:JASTI
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 32ND ST
Mailing Address - Street 2:KMART PHARMACY
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-7363
Mailing Address - Country:US
Mailing Address - Phone:810-989-7610
Mailing Address - Fax:810-982-8400
Practice Address - Street 1:1179 32ND ST
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-7363
Practice Address - Country:US
Practice Address - Phone:810-989-7610
Practice Address - Fax:810-982-8400
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist