Active NPI
Khaled Fares, RPH
- Pharmacist
- Shoreline, WA
National Provider Identifier
1477167807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH61053396
- Practice address
- 17524 Aurora Ave N
Shoreline, WA 98133-4813 - Phone
- (206) 542-4964
- NPI assigned
- Sep 2, 2020
- 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 | PH61053396 | WA | Primary |
Addresses
Primary practice location
17524 Aurora Ave N
Shoreline, WA 98133-4813
Mailing address
21405 54TH PL W
Mountlake Terrace, WA 98043-3023
Phone (425) 429-8000
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
| License | State | Type | Specialty |
|---|---|---|---|
| PH61053396 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599004800000",
"number": "1477167807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21405 54TH PL W",
"city": "MOUNTLAKE TERRACE",
"state": "WA",
"postal_code": "980433023",
"telephone_number": "425-429-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17524 AURORA AVE N",
"city": "SHORELINE",
"state": "WA",
"postal_code": "981334813",
"telephone_number": "206-542-4964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARES",
"first_name": "KHALED",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-02",
"last_updated": "2020-09-02",
"certification_date": "2020-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH61053396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shoreline, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 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.