Khaled Mohamed Aboutaleb, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

PH60458899 Issued in WA

Practice address

405 SE Everett Mall Way
Everett, WA 98208-3243

Phone

(425) 353-7967

Fax

(425) 249-5602

NPI assigned

Jan 29, 2015

Last updated

Aug 5, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438732800000",
    "number": "1780074690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 SE EVERETT MALL WAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083243",
            "telephone_number": "425-353-7967",
            "fax_number": "425-249-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 SE EVERETT MALL WAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083243",
            "telephone_number": "425-353-7967",
            "fax_number": "425-249-5602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABOUTALEB",
        "first_name": "KHALED",
        "middle_name": "MOHAMED",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-29",
        "last_updated": "2015-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH60458899",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "62056",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Everett, WA
• Providers in Everett, WA by specialty
• Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.