Active NPI
Job Pan, PHARMD
- Pharmacist
- Puyallup, WA
National Provider Identifier
1639707482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH60874621
- Practice address
- 401 15TH Ave SE
Puyallup, WA 98372-3715 - Phone
- (253) 697-1885
- NPI assigned
- Mar 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | PH60874621 | WA | Primary |
Addresses
Primary practice location
401 15TH Ave SE
Puyallup, WA 98372-3715
Mailing address
321 S 47TH St Unit a
Renton, WA 98055-5081
Phone (626) 400-9880
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 |
|---|---|---|---|
| PH60874621 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585353600000",
"number": "1639707482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 S 47TH ST UNIT A",
"city": "RENTON",
"state": "WA",
"postal_code": "980555081",
"telephone_number": "626-400-9880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 15TH AVE SE",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983723715",
"telephone_number": "253-697-1885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAN",
"first_name": "JOB",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-28",
"last_updated": "2020-03-28",
"certification_date": "2020-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60874621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.