Active NPI
Noura Khattab
- Pharmacist
- Tallahassee, FL
National Provider Identifier
1922610351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS54826
- Practice address
- 6475 Tracy LN
Tallahassee, FL 32309-2174 - Phone
- (248) 212-4542
- NPI assigned
- Aug 18, 2020
- Last updated
- Aug 18, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | PS54826 | FL | Primary |
Addresses
Primary practice location
6475 Tracy LN
Tallahassee, FL 32309-2174
Mailing address
6880 Thomasville Rd
Tallahassee, FL 32312
Phone (850) 907-1763
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Walgreens | Direct |
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 |
|---|---|---|---|
| PS54826 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597708800000",
"number": "1922610351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6880 THOMASVILLE RD",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "32312",
"telephone_number": "850-907-1763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6475 TRACY LN",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323092174",
"telephone_number": "248-212-4542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHATTAB",
"first_name": "NOURA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-18",
"last_updated": "2020-08-18",
"certification_date": "2020-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS54826",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Walgreens",
"affiliation": "N",
"endpointDescription": "Walgreens",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"contentOtherDescription": "Other",
"address_1": "6680 Thomasville Rd",
"city": "Tallahassee",
"state": "FL",
"country_code": "US",
"postal_code": "323123836",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tallahassee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.