Active NPI
Kim Ngoc Etheart, PHARM.D
- Pharmacist
- Rohnert Park, CA
National Provider Identifier
1265939102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 53875
- Practice address
- 4625 Redwood Dr
Rohnert Park, CA 94928-7941 - Phone
- (707) 586-3612
- Fax
- (707) 586-3624
- NPI assigned
- Apr 8, 2018
- 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 | 53875 | CA | Primary |
Addresses
Primary practice location
4625 Redwood Dr
Rohnert Park, CA 94928-7941
Mailing address
4625 Redwood Dr
Rohnert Park, CA 94928-7943
Phone (707) 586-3612
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 |
|---|---|---|---|
| 53875 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523145600000",
"number": "1265939102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4625 REDWOOD DR",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949287943",
"telephone_number": "707-586-3612",
"fax_number": "707-586-3624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4625 REDWOOD DR",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949287941",
"telephone_number": "707-586-3612",
"fax_number": "707-586-3624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETHEART",
"first_name": "KIM NGOC",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-08",
"last_updated": "2018-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "53875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.