Max Dwight Phelps, PH00009411

Primary specialty

Geriatric PharmacistTaxonomy code 1835G0303X

License

PH00009411 Issued in WA

Practice address

25316 74TH Ave S Ste 105
Kent, WA 98032-6022

Phone

(800) 562-8386

Fax

(800) 421-7772

NPI assigned

Nov 15, 2019

Last updated

Nov 15, 2019By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Pharmacy Corporation of America

  dba Pharmerica

  • Long Term Care Pharmacy
  • Kent, WA
  • NPI 1609809284
  NPD
• Pharmacy Corporation of America

  dba PharMerica

  • Long Term Care Pharmacy
  • Milwaukee, WI
  • NPI 1124665336
  NPD (past)

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

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1427693258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23234 114TH WAY SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980313429",
            "telephone_number": "206-683-1035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25316 74TH AVE S STE 105",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980326022",
            "telephone_number": "800-562-8386",
            "fax_number": "800-421-7772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "MAX",
        "middle_name": "DWIGHT",
        "credential": "PH00009411",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-15",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "WA",
            "license": "PH00009411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thuy Pham, DO
• Hoaichi Phan, D.M.D.
• Carla Phaneuf Viltz, BA, CDP
• Pharmacy Corporation of America (Pharmerica)
• Erica Phelps, OT
• Sydney Phelps
• Juwuan Phomprida-Robinson
• Xaisongkhame Phonexaiya, LMT
• Phuc T Phung, MD
• Physical Therapy Northwest, PLLC (Precision Physical Therapy)

• Geriatric Pharmacist in Kent, WA
• Providers in Kent, WA by specialty
• Geriatric Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2019; 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.