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1164893475 NPI number — KEITH WELLMAN PHARMD

NPI Number: 1164893475
Health Care Provider/Practitioner: KEITH WELLMAN PHARMD

Information about “1164893475” NPI (KEITH WELLMAN PHARMD) exists in 1164893475 in HTML format HTML  |  1164893475 in plain Text format TXT  |  1164893475 in PDF (Portable Document Format) PDF  |  1164893475 in an XML format XML  formats.

NPI Number : 1164893475 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164893475",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WELLMAN",
    "FirstName": "KEITH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2019 SMOKETREE VILLAGE CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HENDERSON",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89012-2167",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2019 SMOKETREE VILLAGE CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HENDERSON",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89012-2167",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-403-0253",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/13/2015",
    "LastUpdateDate": "10/13/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "19012",
        "LicenseNumberStateCode": "NV",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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