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

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 and National Provider Directory roles.

• Pharmacy Corporation of America

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

  • 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
• Erica Phelps, OT
• Sydney Phelps
• Juwuan Phomprida-Robinson
• Xaisongkhame Phonexaiya, LMT
• Phuc T Phung, MD
• Physical Therapy Northwest, PLLC

• 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.