Individual provider Active NPI

Magdaline Mouratides

  • Pharmacist
  • Crown Point, IN
National Provider Identifier
1053915306
Registry record updated Nov 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
26028380A Issued in IN
Practice address
100 E State Road 231
Crown Point, IN 46307-7495
Phone
(219) 662-8854
NPI assigned
Nov 27, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 26028380A IN Primary

Addresses

Primary practice location

100 E State Road 231
Crown Point, IN 46307-7495

Mailing address

100 E State Road 231
Crown Point, IN 46307-7495

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

LicenseStateTypeSpecialty
26028380AINMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606435200000",
    "number": "1053915306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E STATE ROAD 231",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E STATE ROAD 231",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077495",
            "telephone_number": "219-662-8854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOURATIDES",
        "first_name": "MAGDALINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-27",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "26028380A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crown Point, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.

Verify at the official NPI Registry.