Active NPI
Jonathan Ebrom, PHARMD
- Pharmacist
- San Diego, CA
National Provider Identifier
1154779247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 69608
- Practice address
- 1450 Columbia St
San Diego, CA 92101-3487 - Phone
- (760) 452-3522
- Fax
- (619) 268-8158
- NPI assigned
- May 30, 2016
- 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 | 69608 | CA | Primary |
Addresses
Primary practice location
1450 Columbia St
San Diego, CA 92101-3487
Mailing address
1450 Columbia St
San Diego, CA 92101-3487
Phone (760) 452-3522
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 |
|---|---|---|---|
| 69608 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635120000000",
"number": "1154779247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1450 COLUMBIA ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921013487",
"telephone_number": "760-452-3522",
"fax_number": "619-268-8158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 COLUMBIA ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921013487",
"telephone_number": "760-452-3522",
"fax_number": "619-268-8158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBROM",
"first_name": "JONATHAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-30",
"last_updated": "2021-10-25",
"certification_date": "2021-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "69608",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.