NPIMap

Individual provider Active NPI

Aghogho Francis Eruotor

  • Pharmacist
  • University Place, WA
National Provider Identifier
1497105209
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH60643359 Issued in WA
Practice address
3840 Bridgeport Way W
University Place, WA 98466-4416
Phone
(253) 564-2255
Fax
(253) 564-0189
NPI assigned
Jun 13, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH60643359 WA Primary

Addresses

Primary practice location

3840 Bridgeport Way W
University Place, WA 98466-4416

Mailing address

3811 78TH Avenue CT W
Apt J303
University Place, WA 98466-3259
Phone (780) 200-8650

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

LicenseStateTypeSpecialty
PH60643359WAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Thrifty Payless Inc Past Accepting new patients
Thrifty Payless Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465776000000",
    "number": "1497105209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3811 78TH AVENUE CT W",
            "address_2": "APT J303",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984663259",
            "telephone_number": "780-200-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664416",
            "telephone_number": "253-564-2255",
            "fax_number": "253-564-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERUOTOR",
        "first_name": "AGHOGHO",
        "middle_name": "FRANCIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-13",
        "last_updated": "2016-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH60643359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; 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.