NPIMap

Individual provider Active NPI

Phil Mace, PHARMD

  • Pharmacist
  • Longview, WA
National Provider Identifier
1124375506
Registry record updated Aug 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH60284334 Issued in WA
Practice address
3184 Ocean Beach Hwy
Longview, WA 98632-4378
Phone
(360) 425-6222
Fax
(360) 636-6731
NPI assigned
Aug 5, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH60284334 WA Primary

Addresses

Primary practice location

3184 Ocean Beach Hwy
Longview, WA 98632-4378

Mailing address

3184 Ocean Beach Hwy
Longview, WA 98632-4378
Phone (360) 425-6222

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

LicenseStateTypeSpecialty
PH60284334WAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Fred Meyer Stores Inc. Past Accepting new patients
Fred Meyer Stores Inc 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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344124800000",
    "number": "1124375506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3184 OCEAN BEACH HWY",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986324378",
            "telephone_number": "360-425-6222",
            "fax_number": "360-636-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3184 OCEAN BEACH HWY",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986324378",
            "telephone_number": "360-425-6222",
            "fax_number": "360-636-6731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACE",
        "first_name": "PHIL",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-05",
        "last_updated": "2012-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH60284334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.