Active NPI
Gordon Arthur Pomerenke
- Pharmacist
- Bonney Lake, WA
National Provider Identifier
1386053247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00020202
- Practice address
- 19205 Sr 410 E
Bonney Lake, WA 98391-6305 - Phone
- (253) 826-9151
- Fax
- (253) 826-9153
- NPI assigned
- Aug 5, 2014
- Sex
- Male
- 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 | PH00020202 | WA | Primary |
Addresses
Primary practice location
19205 Sr 410 E
Bonney Lake, WA 98391-6305
Mailing address
19205 Sr 410 E
Bonney Lake, WA 98391-6305
Phone (253) 826-9151
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 |
|---|---|---|---|
| PH00020202 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407196800000",
"number": "1386053247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19205 SR 410 E",
"city": "BONNEY LAKE",
"state": "WA",
"postal_code": "983916305",
"telephone_number": "253-826-9151",
"fax_number": "253-826-9153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19205 SR 410 E",
"city": "BONNEY LAKE",
"state": "WA",
"postal_code": "983916305",
"telephone_number": "253-826-9151",
"fax_number": "253-826-9153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POMERENKE",
"first_name": "GORDON",
"middle_name": "ARTHUR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-05",
"last_updated": "2014-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00020202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonney Lake, WA
- Performance Sports and Spine Physical Therapy PS
- Brandon Edward Perkes, DC
- Alexandrea Lee Pettyjohn, LMP
- Mary Ellen Pfeiffer, B.A., L.M.P.
- Crystal Gayle Phillips, COTA/L
- Emily R Potter, R.PH.
- Heather Lynn Prescott, LICSW
- Janessa Pallasigui Pressley, PHARM D
- Prestige Mental Health
- Principal Health Clinic LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.