Active NPI
Mohmmad Khoshneviszadeh
- Ambulatory Care Pharmacist
- Independence, MO
National Provider Identifier
1306332622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Care Pharmacist
- License
- 044343
- Practice address
- 4100 S Bolger Rd
Independence, MO 64055-6772 - Phone
- (816) 350-2931
- NPI assigned
- Jul 10, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | 044343 | MO | Primary |
Addresses
Primary practice location
4100 S Bolger Rd
Independence, MO 64055-6772
Mailing address
5128 S Tierney Dr
Independence, MO 64055-6939
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 |
|---|---|---|---|
| 044343 | MO | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531180800000",
"number": "1306332622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5128 S TIERNEY DR",
"city": "INDEPENDENCE",
"state": "MO",
"postal_code": "640556939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 S BOLGER RD",
"city": "INDEPENDENCE",
"state": "MO",
"postal_code": "640556772",
"telephone_number": "816-350-2931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOSHNEVISZADEH",
"first_name": "MOHMMAD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-07-10",
"last_updated": "2018-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist, Ambulatory Care",
"state": "MO",
"license": "044343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Independence, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.