Preben Ehlers Ebbesen, RPH, PHARM D

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH36685 Issued in CA

Practice address

3550 North G Street
Raley'S Pharmacy #309
Merced, CA 95340-0691

Phone

(209) 722-3853

Fax

(209) 722-1711

NPI assigned

May 15, 2014

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy, Registered Pharmacist

State licenses

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

{
    "created_epoch": "1400112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400457600000",
    "number": "1487065041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 NORTH G STREET",
            "address_2": "RALEY'S PHARMACY #309",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953400691",
            "telephone_number": "209-722-3853",
            "fax_number": "209-722-1711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 NORTH G STREET",
            "address_2": "RALEY'S PHARMACY #309",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953400691",
            "telephone_number": "209-722-3853",
            "fax_number": "209-722-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBBESEN",
        "first_name": "PREBEN",
        "middle_name": "EHLERS",
        "name_prefix": "Mr.",
        "credential": "RPH, PHARM D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-15",
        "last_updated": "2014-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "RPH36685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED PHARMACIST CALIFORNIA",
            "identifier": "RPH36685",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dva Renal Healthcare Inc
• Simrit Singh Dyal, MD
• Lauren Dykema, ATC
• Laurel Christine Ealy, PSYD
• Yabriyah Eaves, PA-C
• Douglas Johnson Eck, MD
• Shannon Edmonds, RN, BSN, CCM
• Edward Yoo DDS Inc
• Brendan James Edwards
• Kim Eggerud, DNP, FNP-C

• Pharmacist in Merced, CA
• Providers in Merced, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; 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.