Active NPI
Gary Michael Lagerstrom, PHARM D
- Pharmacist
- Bonney Lake, WA
National Provider Identifier
1407004385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00065014
- Practice address
- 9230 Sky Island Drive East
Bonney Lake, WA 98391-0000 - Phone
- (253) 750-6050
- Fax
- (253) 750-6055
- NPI assigned
- Sep 3, 2008
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH00065014 | WA | Primary |
Addresses
Primary practice location
9230 Sky Island Drive East
Bonney Lake, WA 98391-0000
Mailing address
9230 Sky Island Dr E
Bonney Lake, WA 98391
Phone (253) 750-6050
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00065014 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375228800000",
"number": "1407004385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9230 SKY ISLAND DR E",
"city": "BONNEY LAKE",
"state": "WA",
"postal_code": "98391",
"telephone_number": "253-750-6050",
"fax_number": "253-750-6055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9230 SKY ISLAND DRIVE EAST",
"city": "BONNEY LAKE",
"state": "WA",
"postal_code": "983910000",
"telephone_number": "253-750-6050",
"fax_number": "253-750-6055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAGERSTROM",
"first_name": "GARY",
"middle_name": "MICHAEL",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-03",
"last_updated": "2013-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00065014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonney Lake, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.