Jack Mountain, PHARMD

Primary specialty

Ambulatory Care PharmacistTaxonomy code 1835P2201X

License

RPH06662 Issued in RI

Practice address

117 Chapman St Ste 200
Providence, RI 02905-5400

Phone

(401) 444-9909

NPI assigned

Jul 13, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1265111769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391099",
            "telephone_number": "617-655-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 CHAPMAN ST STE 200",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029055400",
            "telephone_number": "401-444-9909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1493 Cambridge St",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MA",
            "postal_code": "021391099",
            "country_code": "US",
            "telephone_number": "617-665-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOUNTAIN",
        "first_name": "JACK",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-13",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "PH241587",
            "primary": false
        },
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "RI",
            "license": "RPH06662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Le Roy Moulton, MD
• Bailey Moulton
• Haley Moulton, MD
• Linda Moulton, RNP
• Mary Mounier
• Abdul Rahman Mourad, M.D.
• Andre Jiorjios Moussa Kassis, MD
• Khadija Joy Moussadek, MD
• Abdelmoniem Moustafa, MD
• Farah Moustafa, MD

• Ambulatory Care Pharmacist in Providence, RI
• Providers in Providence, RI by specialty
• Ambulatory Care Pharmacist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; 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.