Individual provider Active NPI

Mimi McClellan, PHARMD

  • Pharmacist
  • Spokane, WA
National Provider Identifier
1518366244
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH00066193 Issued in WA
Practice address
914 W Carlisle Ave
Spokane, WA 99205-3309
Phone
(509) 444-8200
NPI assigned
Aug 19, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH00066193 WA Primary

Addresses

Primary practice location

914 W Carlisle Ave
Spokane, WA 99205-3309

Mailing address

611 N Iron Bridge Way
Spokane, WA 99202-4932
Phone (509) 444-8888

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)
Enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
PH00066193WAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Reliant RX, LLC Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients
Community Health Association of Spokane Past Accepting new patients

Organizations & group practices 4

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": "1408406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1518366244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 N IRON BRIDGE WAY",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992024932",
            "telephone_number": "509-444-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 W CARLISLE AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992053309",
            "telephone_number": "509-444-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLELLAN",
        "first_name": "MIMI",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-19",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00066193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.