Active NPI
Mehdi Ibnoulkhatib
- Pharmacist
- Waterbury, CT
National Provider Identifier
1154819019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0011244
- Practice address
- 910 Wolcott St
Waterbury, CT 06705-1317 - Phone
- (203) 759-1637
- Fax
- (203) 759-1843
- NPI assigned
- Apr 26, 2018
- 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 | 0011244 | CT | Primary |
Addresses
Primary practice location
910 Wolcott St
Waterbury, CT 06705-1317
Mailing address
910 Wolcott St
Waterbury, CT 06705-1317
Phone (203) 759-1637
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000000000000 | Other | CT | 00000000000000 |
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 |
|---|---|---|---|
| 0011244 | CT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524700800000",
"number": "1154819019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "910 WOLCOTT ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067051317",
"telephone_number": "203-759-1637",
"fax_number": "203-759-1843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 WOLCOTT ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067051317",
"telephone_number": "203-759-1637",
"fax_number": "203-759-1843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBNOULKHATIB",
"first_name": "MEHDI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-26",
"last_updated": "2018-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "0011244",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "00000000000000",
"identifier": "0000000000000",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.