Active NPI
Thomas Fattah
- Pharmacist
- Henrico, VA
National Provider Identifier
1417360199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202218240
- Practice address
- 11500 W Broad St
Henrico, VA 23233-1117 - Phone
- (804) 360-2531
- NPI assigned
- Jun 10, 2014
- Last updated
- Nov 12, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202218240 | VA | Primary |
| Pharmacist | 183500000X | I057170 | NY |
Addresses
Primary practice location
11500 W Broad St
Henrico, VA 23233-1117
Mailing address
11500 W Broad St
Henrico, VA 23233-1117
Other practice location 1
14 Soundview Market Pl
Port Washington, NY 11050-2221
Phone (516) 883-8830
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 |
|---|---|---|---|
| I057170 | NY | MD | Pharmacist |
| 0202218240 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
11500 W Broad St
Richmond, VA 23233
Phone (804) 360-2531
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": "1402358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605139200000",
"number": "1417360199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11500 W BROAD ST",
"city": "HENRICO",
"state": "VA",
"postal_code": "232331117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11500 W BROAD ST",
"city": "HENRICO",
"state": "VA",
"postal_code": "232331117",
"telephone_number": "804-360-2531"
}
],
"practiceLocations": [
{
"address_1": "14 Soundview Market Pl",
"address_purpose": "LOCATION",
"city": "Port Washington",
"state": "NY",
"postal_code": "110502221",
"country_code": "US",
"telephone_number": "516-883-8830",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FATTAH",
"first_name": "THOMAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-10",
"last_updated": "2020-11-12",
"certification_date": "2020-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202218240",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "I057170",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henrico, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.