Active NPI
Aye Win Tin Ichwan, PHARMD
- Pharmacist
- Palo Alto, CA
National Provider Identifier
1972030690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 74661
- Practice address
- 2701 Middlefield Rd
Palo Alto, CA 94306-2518 - Phone
- (650) 330-0132
- NPI assigned
- May 11, 2017
- Last updated
- Jan 8, 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 | 74661 | CA | Primary |
Addresses
Primary practice location
2701 Middlefield Rd
Palo Alto, CA 94306-2518
Mailing address
12051 Imperial Hwy
Norwalk, CA 90650-3084
Phone (562) 484-9849
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 |
|---|---|---|---|
| 74661 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longs Drug Store California LLC | Past | Accepting new patients | |
| Longs Drug Stores California LLC | 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": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578441600000",
"number": "1972030690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12051 IMPERIAL HWY",
"city": "NORWALK",
"state": "CA",
"postal_code": "906503084",
"telephone_number": "562-484-9849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 MIDDLEFIELD RD",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943062518",
"telephone_number": "650-330-0132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ICHWAN",
"first_name": "AYE",
"middle_name": "WIN TIN",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-11",
"last_updated": "2020-01-08",
"certification_date": "2020-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "74661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.