Active NPI
Kristen Moore, CPHT
- Pharmacy Technician
- Flat Rock, MI
National Provider Identifier
1063093052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 5303034532
- Practice address
- 26100 Vreeland Rd
Flat Rock, MI 48134-1692 - Phone
- (734) 984-1110
- NPI assigned
- Apr 20, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 5303034532 | MI | Primary |
Addresses
Primary practice location
26100 Vreeland Rd
Flat Rock, MI 48134-1692
Mailing address
25738 Connery Dr
Flat Rock, MI 48134-1816
Phone (662) 524-5435
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | meijer | Direct |
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 |
|---|---|---|---|
| 5303034532 | MI | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meijer Inc | Past | Accepting new patients | |
| Meijer, Inc. | 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": "1618876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618876800000",
"number": "1063093052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25738 CONNERY DR",
"city": "FLAT ROCK",
"state": "MI",
"postal_code": "481341816",
"telephone_number": "662-524-5435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26100 VREELAND RD",
"city": "FLAT ROCK",
"state": "MI",
"postal_code": "481341692",
"telephone_number": "734-984-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "KRISTEN",
"credential": "CPHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-20",
"last_updated": "2021-04-20",
"certification_date": "2021-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "MI",
"license": "5303034532",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "meijer",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "26100 Vreeland Rd",
"city": "Flat Rock",
"state": "MI",
"country_code": "US",
"postal_code": "481341692",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Flat Rock, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.