Active NPI
Shiva Khosravi Moghadam, RPH
- Pharmacist
- Kirkland, WA
National Provider Identifier
1891065660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00043094
- Practice address
- 12405 NE 85TH St
Kirkland, WA 98033-8032 - Phone
- (425) 822-9202
- Fax
- (425) 822-9407
- NPI assigned
- Jan 10, 2012
- Sex
- Female
- 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 | PH00043094 | WA | Primary |
Addresses
Primary practice location
12405 NE 85TH St
Kirkland, WA 98033-8032
Mailing address
12430 93Rd Ave NE
Kirkland, WA 98034-5913
Phone (818) 744-0283
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
| License | State | Type | Specialty |
|---|---|---|---|
| PH00043094 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326153600000",
"number": "1891065660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12430 93RD AVE NE",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980345913",
"telephone_number": "818-744-0283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12405 NE 85TH ST",
"city": "KIRKLAND",
"state": "WA",
"postal_code": "980338032",
"telephone_number": "425-822-9202",
"fax_number": "425-822-9407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOSRAVI MOGHADAM",
"first_name": "SHIVA",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-10",
"last_updated": "2012-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00043094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kirkland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.