Active NPI
Collin Mould
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Las Vegas, NV
National Provider Identifier
1053995902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 20726
- Practice address
- 5610 Centennial Center Blvd
Las Vegas, NV 89149-7104 - Phone
- (702) 395-3282
- NPI assigned
- May 7, 2021
- Sex
- Male
- Sole proprietor
- No
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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 20726 | NV | Primary |
Addresses
Primary practice location
5610 Centennial Center Blvd
Las Vegas, NV 89149-7104
Mailing address
6525 Sierra Diablo Ave
Las Vegas, NV 89130-1869
Phone (702) 449-4219
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4276513 | Other | WALGREENS PHARMACY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | 1245402916 | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 20726 | NV | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620345600000",
"number": "1053995902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6525 SIERRA DIABLO AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891301869",
"telephone_number": "702-449-4219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5610 CENTENNIAL CENTER BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891497104",
"telephone_number": "702-395-3282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULD",
"first_name": "COLLIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-07",
"last_updated": "2021-05-07",
"certification_date": "2021-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "NV",
"license": "20726",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WALGREENS PHARMACY",
"identifier": "4276513",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "1245402916",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "5610 Centennial Center Blvd",
"city": "Las Vegas",
"state": "NV",
"country_code": "US",
"postal_code": "891497104",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.