Individual provider Active NPI

Jephete Moise Prophete, PHARMD

  • Pharmacist
  • Bronx, NY
National Provider Identifier
1114675774
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
068868 Issued in NY
Practice address
1160 E Tremont Ave
Bronx, NY 10460-2452
Phone
(631) 458-7258
NPI assigned
Mar 14, 2022
Last updated
Mar 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 068868 NY Primary

Addresses

Primary practice location

1160 E Tremont Ave
Bronx, NY 10460-2452

Mailing address

9716 222ND St
Queens Village, NY 11429-1362
Phone (646) 837-1939

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
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
068868NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Morris Park Pharmacy Inc CurrentSince Mar 20, 2022 Accepting new patients
Morris Park Pharmacy Inc CurrentSince Dec 28, 2025 Accepting new patients

Locations

1160 E Tremont Ave
Bronx, NY 10460
Phone (631) 458-7258

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": "1647216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1114675774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9716 222ND ST",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291362",
            "telephone_number": "646-837-1939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 E TREMONT AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104602452",
            "telephone_number": "631-458-7258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROPHETE",
        "first_name": "JEPHETE",
        "middle_name": "MOISE",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "068868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.