Active NPI
Elisa O Kim, RPH
- Pharmacist
- Des Moines, WA
National Provider Identifier
1326348749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 00064091
- Practice address
- 21401 Pacific Hwy S
Des Moines, WA 98198-6074 - Phone
- (206) 824-4784
- Fax
- (206) 878-3208
- NPI assigned
- Nov 1, 2010
- Last updated
- Nov 1, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 00064091 | WA | Primary |
Addresses
Primary practice location
21401 Pacific Hwy S
Des Moines, WA 98198-6074
Mailing address
21401 Pacific Hwy S
Des Moines, WA 98198-6074
Phone (206) 824-4784
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00064091 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | 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": "1288569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288569600000",
"number": "1326348749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21401 PACIFIC HWY S",
"city": "DES MOINES",
"state": "WA",
"postal_code": "981986074",
"telephone_number": "206-824-4784",
"fax_number": "206-878-3208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21401 PACIFIC HWY S",
"city": "DES MOINES",
"state": "WA",
"postal_code": "981986074",
"telephone_number": "206-824-4784",
"fax_number": "206-878-3208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ELISA",
"middle_name": "O",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-01",
"last_updated": "2010-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "00064091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.