Active NPI
Wasien Arthur Phungkusol
- Pharmacist
- Rancho Cucamonga, CA
National Provider Identifier
1801434576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 81619
- Practice address
- 7555 Marmande PL
Rancho Cucamonga, CA 91730-6752 - Phone
- (909) 851-8951
- NPI assigned
- Dec 12, 2019
- 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 | 81619 | CA | Primary |
Addresses
Primary practice location
7555 Marmande PL
Rancho Cucamonga, CA 91730-6752
Mailing address
7555 Marmande PL
Rancho Cucamonga, CA 91730-6752
Phone (909) 851-8951
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 81619 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576108800000",
"number": "1801434576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7555 MARMANDE PL",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917306752",
"telephone_number": "909-851-8951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7555 MARMANDE PL",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917306752",
"telephone_number": "909-851-8951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHUNGKUSOL",
"first_name": "WASIEN",
"middle_name": "ARTHUR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-12",
"last_updated": "2019-12-12",
"certification_date": "2019-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "81619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.