Active NPI
Mekdes Kebede
- Pharmacist
- Mishawaka, IN
National Provider Identifier
1265824460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302041832
- Practice address
- 503 E 14TH St
Mishawaka, IN 46544-5527 - Phone
- (317) 698-0240
- NPI assigned
- Feb 24, 2015
- Sex
- Female
- 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 | 5302041832 | MI | Primary |
Addresses
Primary practice location
503 E 14TH St
Mishawaka, IN 46544-5527
Mailing address
503 E 14TH St
Mishawaka, IN 46544-5527
Phone (317) 698-0240
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 |
|---|---|---|---|
| 5302041832 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424736000000",
"number": "1265824460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 E 14TH ST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465445527",
"telephone_number": "317-698-0240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "503 E 14TH ST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465445527",
"telephone_number": "317-698-0240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEBEDE",
"first_name": "MEKDES",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-24",
"last_updated": "2015-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302041832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.