Active NPI
Fistume Mulatu, PHARMD
- Pharmacist
- Las Cruces, NM
National Provider Identifier
1952859514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP00009274
- Practice address
- 3011 N Main St
Las Cruces, NM 88001-1164 - Phone
- (575) 647-8878
- NPI assigned
- Sep 13, 2016
- Last updated
- Oct 2, 2021
- Sex
- Male
- 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 | RP00009274 | NM | Primary |
Addresses
Primary practice location
3011 N Main St
Las Cruces, NM 88001-1164
Mailing address
3011 N Main St
Las Cruces, NM 88001-1164
Phone (575) 647-8878
Other practice location 1
940 N Main St
Las Cruces, NM 88001-1124
Phone (575) 524-5900
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP00009274 | NM | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 3
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": "1473724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633132800000",
"number": "1952859514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3011 N MAIN ST",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880011164",
"telephone_number": "575-647-8878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3011 N MAIN ST",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880011164",
"telephone_number": "575-647-8878"
}
],
"practiceLocations": [
{
"address_1": "940 N Main St",
"address_purpose": "LOCATION",
"city": "Las Cruces",
"state": "NM",
"postal_code": "880011124",
"country_code": "US",
"telephone_number": "575-524-5900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MULATU",
"first_name": "FISTUME",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-13",
"last_updated": "2021-10-02",
"certification_date": "2020-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00009274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.