Active NPI
Gideon Mordechai Shakked, RPH
- Pharmacist
- San Diego, CA
National Provider Identifier
1184953747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 62575
- Practice address
- 11080 W Ocean Air Dr
San Diego, CA 92130-4657 - Phone
- (858) 405-0353
- NPI assigned
- Dec 10, 2009
- Sex
- Male
- 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 | 62575 | CA | Primary |
Addresses
Primary practice location
11080 W Ocean Air Dr
San Diego, CA 92130-4657
Mailing address
PO Box 13356
La Jolla, CA 92039-3356
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62575 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260403200000",
"number": "1184953747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13356",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920393356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11080 W OCEAN AIR DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921304657",
"telephone_number": "858-405-0353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAKKED",
"first_name": "GIDEON",
"middle_name": "MORDECHAI",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-10",
"last_updated": "2009-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "62575",
"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 Dec 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.