Active NPI
Prem Khatiwoda
- Pharmacist
- Erie, PA
National Provider Identifier
1487247888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP455413
- Practice address
- 1520 W 26TH St
Erie, PA 16508-1302 - Phone
- (814) 455-9500
- NPI assigned
- Feb 16, 2021
- Sex
- Male
- Sole proprietor
- No
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 | RP455413 | PA | Primary |
Addresses
Primary practice location
1520 W 26TH St
Erie, PA 16508-1302
Mailing address
1222 Mission Dr
Erie, PA 16509-2933
Phone (814) 384-8040
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP455413 | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613433600000",
"number": "1487247888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1222 MISSION DR",
"city": "ERIE",
"state": "PA",
"postal_code": "165092933",
"telephone_number": "814-384-8040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1520 W 26TH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165081302",
"telephone_number": "814-455-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHATIWODA",
"first_name": "PREM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-16",
"last_updated": "2021-02-16",
"certification_date": "2021-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP455413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.