Active NPI
Samuel Kim
- Pharmacist
- Ellensburg, WA
National Provider Identifier
1396337655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH61074268
- Practice address
- 400 N Ruby St
Ellensburg, WA 98926 - Phone
- (509) 962-5096
- NPI assigned
- Feb 8, 2021
- Last updated
- Jul 11, 2022
- 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 | PH61074268 | WA | Primary |
Addresses
Primary practice location
400 N Ruby St
Ellensburg, WA 98926
Mailing address
400 N Ruby St
Ellensburg, WA 98926
Phone (509) 962-5096
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 |
|---|---|---|---|
| PH61074268 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657497600000",
"number": "1396337655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 N RUBY ST",
"city": "ELLENSBURG",
"state": "WA",
"postal_code": "98926",
"telephone_number": "509-962-5096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 N RUBY ST",
"city": "ELLENSBURG",
"state": "WA",
"postal_code": "98926",
"telephone_number": "509-962-5096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SAMUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-08",
"last_updated": "2022-07-11",
"certification_date": "2022-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH61074268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellensburg, WA
- Oriel Keil
- Roberta Key
- Kelly Kilts, M. ED.
- Heesue Kim, RPH
- Jin Ah Kim, PHARM.D.
- Chadrick Halston Kirkpatrick
- Kittitas Anesthesia LLC
- Kittitas County Fire Protection District 2 (Kittitas Valley Fire & Rescue)
- Kittitas County Public Health (Kittitas County Sheriff's Office)
- Kittitas County Public Health
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.