Individual provider Active NPI

Mariam Maher Kandas Michael, RPH

  • Pharmacist
  • Glendora, CA
National Provider Identifier
1790271260
Registry record updated Jul 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
77994 Issued in CA
Practice address
150 S Grand Ave
Glendora, CA 91741-4217
Phone
(626) 385-2442
NPI assigned
Jul 7, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 7, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 60768083 WA
Pharmacist 183500000X 60837 TX
Pharmacist 183500000X 77994 CA Primary

Addresses

Primary practice location

150 S Grand Ave
Glendora, CA 91741-4217

Mailing address

628 E Allen Ave
San Dimas, CA 91773-1525
Phone (310) 592-7149

Other practice location 1

628 E Allen Ave
San Dimas, CA 91773-1525
Phone (310) 592-7149

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
77994CAMDMarriage & Family Therapist
60837TXMDPharmacist
60768083WAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1530921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530921600000",
    "number": "1790271260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 E ALLEN AVE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731525",
            "telephone_number": "310-592-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S GRAND AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414217",
            "telephone_number": "626-385-2442"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "628 E Allen Ave",
            "address_purpose": "LOCATION",
            "city": "San Dimas",
            "state": "CA",
            "postal_code": "917731525",
            "country_code": "US",
            "telephone_number": "310-592-7149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICHAEL",
        "first_name": "MARIAM",
        "middle_name": "MAHER KANDAS",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-07",
        "last_updated": "2018-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "60768083",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "60837",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "77994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2018; 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.