Active NPI
Holly J Mousa, PHARMD
- Pharmacist
- Bandon, OR
National Provider Identifier
1144827544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0018115
- Practice address
- 44 Michigan Ave NE
Bandon, OR 97411-9743 - Phone
- (541) 347-9457
- NPI assigned
- Oct 8, 2020
- Last updated
- Oct 8, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0018115 | OR | Primary |
Addresses
Primary practice location
44 Michigan Ave NE
Bandon, OR 97411-9743
Mailing address
44 Michigan Ave NE
Bandon, OR 97411-9743
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
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0018115 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602115200000",
"number": "1144827544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 MICHIGAN AVE NE",
"city": "BANDON",
"state": "OR",
"postal_code": "974119743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 MICHIGAN AVE NE",
"city": "BANDON",
"state": "OR",
"postal_code": "974119743",
"telephone_number": "541-347-9457"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUSA",
"first_name": "HOLLY",
"middle_name": "J",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-08",
"last_updated": "2020-10-08",
"certification_date": "2020-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0018115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bandon, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.