Kathleen Anne Elevazo Nicanor, PHARMD, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH86761 Issued in CA

Practice address

2647 S Barrington Ave Apt 9
Los Angeles, CA 90064-2852

Phone

(510) 493-8448

NPI assigned

Oct 10, 2022

Last updated

Oct 10, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy, Registered Pharmacist

State licenses

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1255056537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2647 S BARRINGTON AVE APT 9",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900642852",
            "telephone_number": "510-493-8448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2647 S BARRINGTON AVE APT 9",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900642852",
            "telephone_number": "510-493-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICANOR",
        "first_name": "KATHLEEN ANNE",
        "middle_name": "ELEVAZO",
        "credential": "PHARMD, RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP455752",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "RPH86761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amir Niazmand
• Preston Charles Nibley
• Tracy Nibo
• Anca Rodica Nica, D.D.S.
• Jocelyn Nicanor Jimenez
• Pearl J Nicassio
• Perry Michael Nicassio, PHD
• Vincent Michael Nicchi, MD
• Lucas James Nicholaou, DDS
• Nicholas a Rogers MD Inc

• Pharmacist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; 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.