Active NPI
Alaleh Seysan Khademi
- Pharmacist
- Wylie, TX
National Provider Identifier
1063016418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 55862
- Practice address
- 750 W FM 544
Wylie, TX 75098-3913 - Phone
- (704) 905-6877
- NPI assigned
- Nov 25, 2020
- Last updated
- Nov 25, 2020
- 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 | 183500000X | 55862 | TX | Primary |
Addresses
Primary practice location
750 W FM 544
Wylie, TX 75098-3913
Mailing address
3400 Olivia Dr
Wylie, TX 75098-7445
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 |
|---|---|---|---|
| 55862 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606262400000",
"number": "1063016418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 OLIVIA DR",
"city": "WYLIE",
"state": "TX",
"postal_code": "750987445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 W FM 544",
"city": "WYLIE",
"state": "TX",
"postal_code": "750983913",
"telephone_number": "704-905-6877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHADEMI",
"first_name": "ALALEH",
"middle_name": "SEYSAN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-25",
"last_updated": "2020-11-25",
"certification_date": "2020-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "55862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wylie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.