Active NPI
Ny Mim, PHARM D
- Pharmacist
- Modesto, CA
National Provider Identifier
1689651309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 48317
- Practice address
- 2100 Standiford Ave
Modesto, CA 95350-6522 - Phone
- (209) 577-1350
- Fax
- (209) 577-1409
- NPI assigned
- Dec 22, 2005
- 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 | 48317 | CA | Primary |
Addresses
Primary practice location
2100 Standiford Ave
Modesto, CA 95350-6522
Mailing address
4000 Bella Tuscany Dr
Modesto, CA 95356-9339
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 |
|---|---|---|---|
| 48317 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187049600000",
"number": "1689651309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 BELLA TUSCANY DR",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 STANDIFORD AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953506522",
"telephone_number": "209-577-1350",
"fax_number": "209-577-1409"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIM",
"first_name": "NY",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2007-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "48317",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.