Active NPI
Michael Maravich, PHARM. D.
- Pharmacist
- Kelseyville, CA
National Provider Identifier
1154622140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 48738
- Practice address
- 10859 N Slope Dr
Kelseyville, CA 95451-9763 - Phone
- (707) 263-8779
- Fax
- (707) 263-8783
- NPI assigned
- Nov 8, 2010
- 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 | 48738 | CA | Primary |
Addresses
Primary practice location
10859 N Slope Dr
Kelseyville, CA 95451-9763
Mailing address
10859 N Slope Dr
Kelseyville, CA 95451-9763
Phone (707) 263-8779
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 48738 | Other | CA | CALIFORNIA STATE LISCENSE |
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 |
|---|---|---|---|
| 48738 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289174400000",
"number": "1154622140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10859 N SLOPE DR",
"city": "KELSEYVILLE",
"state": "CA",
"postal_code": "954519763",
"telephone_number": "707-263-8779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10859 N SLOPE DR",
"city": "KELSEYVILLE",
"state": "CA",
"postal_code": "954519763",
"telephone_number": "707-263-8779",
"fax_number": "707-263-8783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARAVICH",
"first_name": "MICHAEL",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-11-08",
"last_updated": "2010-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "48738",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA STATE LISCENSE",
"identifier": "48738",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kelseyville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.