Marvin James Waletich, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

PHRM.PH.00009701 Issued in WA

Practice address

117 1St Ave SW
Castle Rock, WA 98611

Phone

(360) 274-8211

Fax

(360) 274-7825

NPI assigned

May 5, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jim Waletich Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kirk'S Drug, Inc

  • Oxygen Equipment & Supplies (DME)
  • Olympia, WA
  • NPI 1215930300
  NPD Authorized official
• Kirks Drug Inc

  • Clinic Pharmacy
  • Lacey, WA
  • NPI 1598903940
  NPD
• Castle Rock Pharmacy Inc

  • Community/Retail Pharmacy
  • Castle Rock, WA
  • NPI 1306857800
  NPD (past)

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

{
    "created_epoch": "1651708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1376289116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "986110188",
            "telephone_number": "360-274-8211",
            "fax_number": "360-274-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 1ST AVE SW",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "98611",
            "telephone_number": "360-274-8211",
            "fax_number": "360-274-7825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALETICH",
        "first_name": "MARVIN",
        "middle_name": "JAMES",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-05",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PHRM.PH.00009701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JIM",
            "last_name": "WALETICH",
            "credential": "RPH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Heather Kristine Temple, CDP
• Kyra Thomas, ATC
• Emma V. Torres-Baltazar, MD
• Chuan Ching Tu
• Renee Amelia Walden, ARNP
• Scott Wambold, LMT
• Lacey Wise, PT

• Pharmacist in Castle Rock, WA
• Providers in Castle Rock, WA by specialty
• Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.