Active NPI
Mo Walts
- Pharmacy Technician
- Vestal, NY
National Provider Identifier
1104604503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 20-102791
- Practice address
- 100 Rano Blvd
Vestal, NY 13850-2776 - Phone
- (607) 763-8712
- NPI assigned
- Sep 18, 2023
- Last updated
- Sep 18, 2023
- 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 | 20-102791 | NY | Primary |
Addresses
Primary practice location
100 Rano Blvd
Vestal, NY 13850-2776
Mailing address
3606 Parti Dr
Cortland, NY 13045-8828
Phone (607) 745-7752
Other names 1
- Mollie Walts
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 |
|---|---|---|---|
| 20-102791 | NY | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1104604503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3606 PARTI DR",
"city": "CORTLAND",
"state": "NY",
"postal_code": "130458828",
"telephone_number": "607-745-7752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 RANO BLVD",
"city": "VESTAL",
"state": "NY",
"postal_code": "138502776",
"telephone_number": "607-763-8712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTS",
"first_name": "MO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-18",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "NY",
"license": "20-102791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MOLLIE",
"last_name": "WALTS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Vestal, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.