Active NPI
Mark Ikeda, PHARMD
- Pharmacist
- Woburn, MA
National Provider Identifier
1770186074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH236756
- Practice address
- 891 Main St
Woburn, MA 01801-1803 - Phone
- (781) 376-1203
- NPI assigned
- Nov 18, 2020
- Last updated
- Nov 18, 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 | PH236756 | MA | Primary |
Addresses
Primary practice location
891 Main St
Woburn, MA 01801-1803
Mailing address
891 Main St
Woburn, MA 01801-1803
Phone (781) 376-1203
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 |
|---|---|---|---|
| PH236756 | MA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1770186074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "891 MAIN ST",
"city": "WOBURN",
"state": "MA",
"postal_code": "018011803",
"telephone_number": "781-376-1203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "891 MAIN ST",
"city": "WOBURN",
"state": "MA",
"postal_code": "018011803",
"telephone_number": "781-376-1203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IKEDA",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-18",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH236756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woburn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.