Active NPI
Jessica Pavlovna Ponkratov, PHARMD
- Pharmacist
- Spokane, WA
National Provider Identifier
1104682053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH61452112
- Practice address
- 2929 E 29TH Ave
Spokane, WA 99223-4811 - Phone
- (509) 535-9056
- NPI assigned
- Feb 27, 2024
- Sex
- Female
- 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 | PH61452112 | WA | Primary |
Addresses
Primary practice location
2929 E 29TH Ave
Spokane, WA 99223-4811
Mailing address
5908 W Rutter Pkwy
Spokane, WA 99208-9220
Phone (360) 431-9047
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 |
|---|---|---|---|
| PH61452112 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708992000000",
"number": "1104682053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5908 W RUTTER PKWY",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992089220",
"telephone_number": "360-431-9047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2929 E 29TH AVE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992234811",
"telephone_number": "509-535-9056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONKRATOV",
"first_name": "JESSICA",
"middle_name": "PAVLOVNA",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-27",
"last_updated": "2024-02-27",
"certification_date": "2024-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH61452112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.