Individual provider Active NPI

Patricia A Klishevich, RPH FASCP

  • Pharmacist
  • Newark, DE
National Provider Identifier
1467574426
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
A10001715 Issued in DE
Practice address
111 Ruthar Dr
Newark, DE 19711-8025
Phone
(800) 727-0123
Fax
(800) 775-3275
NPI assigned
Apr 3, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X A10001715 DE Primary
Pharmacist 183500000X RP028610L PA
Pharmacist 183500000X 16185 MD

Addresses

Primary practice location

111 Ruthar Dr
Newark, DE 19711-8025

Mailing address

96 Louis James CT
Aston, PA 19014-3357
Phone (610) 364-0760

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
A10001715DEMDPharmacist
16185MDMDPharmacist
RP028610LPAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467574426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96 LOUIS JAMES CT",
            "city": "ASTON",
            "state": "PA",
            "postal_code": "190143357",
            "telephone_number": "610-364-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 RUTHAR DR",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197118025",
            "telephone_number": "800-727-0123",
            "fax_number": "800-775-3275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLISHEVICH",
        "first_name": "PATRICIA",
        "middle_name": "A",
        "credential": "RPH FASCP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "DE",
            "license": "A10001715",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP028610L",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "16185",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.