Organization Active NPI

MTM Clinical Care RX

  • Pharmacist
  • Everett, WA
National Provider Identifier
1497273528
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
1477966612 Issued in WA
Legal business name
MTM CLINICAL CARE RX
Practice address
620 SE Everett Mall Way Ste 210B
Everett, WA 98208-3249
Phone
(206) 913-9664
NPI assigned
Sep 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Julie V Le, RPHNPI 1477966612
Title
MTM Pharmacist
Phone
(206) 913-9664

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 1477966612 WA Primary

Addresses

Primary practice location

620 SE Everett Mall Way Ste 210B
Everett, WA 98208-3249

Mailing address

20531 76TH Ave SE
Snohomish, WA 98296-5166
Phone (206) 913-9664

Other identifiers 2

IdentifierTypeStateIssuer
1477966612MedicaidWA
1477966612OtherWAMEDICARE PART-D

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1504915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1497273528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20531 76TH AVE SE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982965166",
            "telephone_number": "206-913-9664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SE EVERETT MALL WAY STE 210B",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083249",
            "telephone_number": "206-913-9664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MTM CLINICAL CARE RX",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-09",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "MTM PHARMACIST",
        "authorized_official_telephone_number": "206-913-9664",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "1477966612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477966612",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART-D",
            "identifier": "1477966612",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.