Active NPI
Mischa Pesicek
- Pharmacist
- Mountain Home, ID
National Provider Identifier
1609220094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P7417
- Practice address
- 2745 American Legion Blvd
Mountain Home, ID 83647-3185 - Phone
- (208) 587-0861
- NPI assigned
- Apr 21, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P7417 | ID | Primary |
| Pharmacist | 183500000X | 24599 | NC | |
| Pharmacist | 183500000X | 55370 | TX | |
| Pharmacist | 183500000X | 03333644 | OH |
Addresses
Primary practice location
2745 American Legion Blvd
Mountain Home, ID 83647-3185
Mailing address
6848 State Route 14
Ravenna, OH 44266-9401
Phone (330) 221-6543
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 |
|---|---|---|---|
| P7417 | ID | MD | Pharmacist |
| 03333644 | OH | MD | Pharmacist |
| 55370 | TX | MD | Pharmacist |
| 24599 | NC | MD | Neurology with Special Qualifications in Child Neurology Physician |
Interoperability endpoints
- mpesicek626259@ehrdirect.uhhospitals.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461196800000",
"number": "1609220094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6848 STATE ROUTE 14",
"city": "RAVENNA",
"state": "OH",
"postal_code": "442669401",
"telephone_number": "330-221-6543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2745 AMERICAN LEGION BLVD",
"city": "MOUNTAIN HOME",
"state": "ID",
"postal_code": "836473185",
"telephone_number": "208-587-0861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PESICEK",
"first_name": "MISCHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-21",
"last_updated": "2016-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P7417",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "24599",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "55370",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03333644",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.