Active NPI
Keith Gilman Fongemie, PHARMD
- Pharmacist
- Federal Way, WA
National Provider Identifier
1629149448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00055424
- Practice address
- 36503 2ND Ave SW
Federal Way, WA 98023-7376 - Phone
- (206) 459-2019
- NPI assigned
- Nov 13, 2006
- 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 | PH00055424 | WA | Primary |
Addresses
Primary practice location
36503 2ND Ave SW
Federal Way, WA 98023-7376
Mailing address
36503 2ND Ave SW
Federal Way, WA 98023-7376
Phone (206) 459-2019
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH00055424 | Other | WA | PHARMACIST LICENSE |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00055424 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398816000000",
"number": "1629149448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36503 2ND AVE SW",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980237376",
"telephone_number": "206-459-2019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36503 2ND AVE SW",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980237376",
"telephone_number": "206-459-2019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONGEMIE",
"first_name": "KEITH",
"middle_name": "GILMAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-13",
"last_updated": "2014-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00055424",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "PH00055424",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Federal Way, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.