Active NPI
Miracle Ruth Edison, PH60920591
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Bellevue, WA
National Provider Identifier
1003461260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 60920591
- Practice address
- 3620 Factoria Blvd SE
Bellevue, WA 98006-6128 - Phone
- (425) 644-7529
- NPI assigned
- Aug 5, 2019
- Last updated
- Aug 5, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 60920591 | WA | Primary |
Addresses
Primary practice location
3620 Factoria Blvd SE
Bellevue, WA 98006-6128
Mailing address
3620 Factoria Blvd SE
Bellevue, WA 98006-6128
Phone (425) 644-7529
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | BARTELLDRUGS.COM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60920591 | WA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Bartell Drug Co | Past | Accepting new patients | |
| The Bartell Drug Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564963200000",
"number": "1003461260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3620 FACTORIA BLVD SE",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980066128",
"telephone_number": "425-644-7529",
"fax_number": "425-502-5482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3620 FACTORIA BLVD SE",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980066128",
"telephone_number": "425-644-7529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDISON",
"first_name": "MIRACLE",
"middle_name": "RUTH",
"credential": "PH60920591",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-05",
"last_updated": "2019-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "WA",
"license": "60920591",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "BARTELLDRUGS.COM",
"affiliation": "N",
"address_1": "3620 Factoria Blvd SE",
"city": "Bellevue",
"state": "WA",
"country_code": "US",
"postal_code": "980066128",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.