Active NPI
Justin Mikitaroff, PHARMD
- Pharmacist
- Renton, WA
National Provider Identifier
1477239341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- IR61441001
- Practice address
- 200 S. 3Rd St
Renton, WA 98057 - Phone
- (425) 255-4151
- NPI assigned
- Jun 26, 2023
- 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 | IR61441001 | WA | Primary |
Addresses
Primary practice location
200 S. 3Rd St
Renton, WA 98057
Mailing address
4721 38TH Ave SW Apt 406
Seattle, WA 98126
Phone (734) 780-5629
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IR61441001 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687737600000",
"number": "1477239341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4721 38TH AVE SW APT 406",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98126",
"telephone_number": "734-780-5629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S. 3RD ST",
"city": "RENTON",
"state": "WA",
"postal_code": "98057",
"telephone_number": "425-255-4151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKITAROFF",
"first_name": "JUSTIN",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-26",
"last_updated": "2023-06-26",
"certification_date": "2023-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "IR61441001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.