Pavel Mitin, PHARMD

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

PH60108956 Issued in WA

Practice address

1505 Kla-Ook-Wa Dr
Taholah, WA 98587

Phone

(360) 276-4405

Fax

(360) 276-0188

NPI assigned

Apr 14, 2020

Last updated

Apr 14, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1225657844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15857 42ND AVE S",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882653",
            "telephone_number": "206-707-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 KLA-OOK-WA DR",
            "city": "TAHOLAH",
            "state": "WA",
            "postal_code": "98587",
            "telephone_number": "360-276-4405",
            "fax_number": "360-276-0188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "915 Anderson Dr",
            "address_purpose": "LOCATION",
            "city": "Aberdeen",
            "state": "WA",
            "postal_code": "985201006",
            "country_code": "US",
            "telephone_number": "360-532-8330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITIN",
        "first_name": "PAVEL",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "WA",
            "license": "PH60108956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mishelle Jackson, SUDPT
• Michelle Elizabeth Kloppman, PHARMACIST
• Gregory G Kozlowski, DDS
• Robert J Lagerquist, CHEMICAL DEPENDENCY
• Kimberly Claire McLaury, R.D.
• Holly Anne Mullins, MASSAGE PRACTITIONER
• Claudia Lee Peterson
• Quinault Chemical Depedency
• Quinault Indian Nation (Roger Saux Health Center)
• Quinault Indian Nation (Roger Saux Health Center)

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Taholah, WA
• Providers in Taholah, WA by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.