Active NPI
Ambartsum Martin Oganov, PHARM D.
- Pharmacist
- Moses Lake, WA
National Provider Identifier
1235565599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH60368859
- Practice address
- 200 E Broadway Ave
Moses Lake, WA 98837-1718 - Phone
- (509) 765-1217
- Fax
- (509) 765-4410
- NPI assigned
- Sep 18, 2013
- 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 | PH60368859 | WA | Primary |
Addresses
Primary practice location
200 E Broadway Ave
Moses Lake, WA 98837-1718
Mailing address
200 E Broadway Ave
Moses Lake, WA 98837-1718
Phone (509) 765-1217
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 |
|---|---|---|---|
| PH60368859 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379462400000",
"number": "1235565599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E BROADWAY AVE",
"city": "MOSES LAKE",
"state": "WA",
"postal_code": "988371718",
"telephone_number": "509-765-1217",
"fax_number": "509-765-4410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E BROADWAY AVE",
"city": "MOSES LAKE",
"state": "WA",
"postal_code": "988371718",
"telephone_number": "509-765-1217",
"fax_number": "509-765-4410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OGANOV",
"first_name": "AMBARTSUM",
"middle_name": "MARTIN",
"credential": "PHARM D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-18",
"last_updated": "2013-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60368859",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moses Lake, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.