Active NPI
Desarone Chanthavong, RPH
- Pharmacist
- Vancouver, WA
National Provider Identifier
1912208232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00017390
- Practice address
- 11696 NE 76TH St
Vancouver, WA 98662-3941 - Phone
- (360) 944-2665
- Fax
- (360) 944-2669
- NPI assigned
- Nov 3, 2010
- 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 | PH00017390 | WA | Primary |
Addresses
Primary practice location
11696 NE 76TH St
Vancouver, WA 98662-3941
Mailing address
11696 NE 76TH St
Vancouver, WA 98662-3941
Phone (360) 944-2665
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 |
|---|---|---|---|
| PH00017390 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Queen Creek, AZ
- NPI 1730040973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288742400000",
"number": "1912208232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11696 NE 76TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986623941",
"telephone_number": "360-944-2665",
"fax_number": "360-944-2669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11696 NE 76TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986623941",
"telephone_number": "360-944-2665",
"fax_number": "360-944-2669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANTHAVONG",
"first_name": "DESARONE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-03",
"last_updated": "2010-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00017390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.