Active NPI
Philip Aaron Ettedgui, PHARMD
- Pharmacist
- Los Angeles, CA
National Provider Identifier
1013569565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 49611
- Practice address
- 5060 W Sunset Blvd Ste C
Los Angeles, CA 90027-5872 - Phone
- (323) 667-1111
- Fax
- (323) 667-1131
- NPI assigned
- Jul 15, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 | 183500000X | 49611 | CA | Primary |
Addresses
Primary practice location
5060 W Sunset Blvd Ste C
Los Angeles, CA 90027-5872
Mailing address
12137 Tiara St
Valley Village, CA 91607-1118
Phone (818) 259-5375
Other practice location 1
2519 W Burbank Blvd
Burbank, CA 91505-2302
Phone (818) 736-5290
Other practice location 2
18625 Sherman Way Ste 107
Reseda, CA 91335-4187
Phone (818) 881-2998
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49611 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Creative Cures Pharmacy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Valley Village, CA
- NPI 1659812519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563148800000",
"number": "1013569565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12137 TIARA ST",
"city": "VALLEY VILLAGE",
"state": "CA",
"postal_code": "916071118",
"telephone_number": "818-259-5375",
"fax_number": "818-881-2996"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5060 W SUNSET BLVD STE C",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900275872",
"telephone_number": "323-667-1111",
"fax_number": "323-667-1131"
}
],
"practiceLocations": [
{
"address_1": "2519 W Burbank Blvd",
"address_purpose": "LOCATION",
"city": "Burbank",
"state": "CA",
"postal_code": "915052302",
"country_code": "US",
"telephone_number": "818-736-5290",
"fax_number": "818-736-5276",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "18625 Sherman Way Ste 107",
"address_purpose": "LOCATION",
"city": "Reseda",
"state": "CA",
"postal_code": "913354187",
"country_code": "US",
"telephone_number": "818-881-2998",
"fax_number": "818-881-2996",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ETTEDGUI",
"first_name": "PHILIP",
"middle_name": "AARON",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-07-15",
"last_updated": "2019-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "49611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.