Active NPI
Gordon Hedenstrom
- Pharmacist
- Pullman, WA
National Provider Identifier
1114728532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00015324
- Practice address
- 1285 SW Center St Apt O
Pullman, WA 99163-5808 - Phone
- (509) 999-8116
- Fax
- (509) 999-8116
- NPI assigned
- Mar 21, 2025
- Sex
- Male
- 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 | PH00015324 | WA | Primary |
Addresses
Primary practice location
1285 SW Center St Apt O
Pullman, WA 99163-5808
Mailing address
1285 SW Center St Apt O
Pullman, WA 99163-5808
Phone (509) 999-8116
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 |
|---|---|---|---|
| PH00015324 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742515200000",
"number": "1114728532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1285 SW CENTER ST APT O",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991635808",
"telephone_number": "509-999-8116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1285 SW CENTER ST APT O",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991635808",
"telephone_number": "509-999-8116",
"fax_number": "509-999-8116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEDENSTROM",
"first_name": "GORDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-03-21",
"last_updated": "2025-03-21",
"certification_date": "2025-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00015324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pullman, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.