Active NPI
Nadia Phouphommakhith
- Pharmacist
- Coralville, IA
National Provider Identifier
1184402653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 24862
- Practice address
- 1914 8TH St
Coralville, IA 52241-1612 - Phone
- (319) 351-3880
- NPI assigned
- Sep 18, 2023
- Last updated
- Sep 18, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 | 24862 | IA | Primary |
Addresses
Primary practice location
1914 8TH St
Coralville, IA 52241-1612
Mailing address
2273 Eversull LN
North Liberty, IA 52317-8085
Phone (815) 980-9001
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 |
|---|---|---|---|
| 24862 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1184402653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2273 EVERSULL LN",
"city": "NORTH LIBERTY",
"state": "IA",
"postal_code": "523178085",
"telephone_number": "815-980-9001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1914 8TH ST",
"city": "CORALVILLE",
"state": "IA",
"postal_code": "522411612",
"telephone_number": "319-351-3880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHOUPHOMMAKHITH",
"first_name": "NADIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-18",
"last_updated": "2023-09-18",
"certification_date": "2023-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "24862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coralville, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.