Active NPI
Quintet Nyessie McKinley, CPHT
- Community/Retail Pharmacy
- Alsip, IL
National Provider Identifier
1346833407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 049243907
- Practice address
- 12290 S Pulaski Rd
Alsip, IL 60803-1405 - Phone
- (708) 385-2006
- NPI assigned
- Feb 18, 2021
- Last updated
- Feb 18, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 049243907 | IL | Primary |
Addresses
Primary practice location
12290 S Pulaski Rd
Alsip, IL 60803-1405
Mailing address
16820 Trapet Ave
Hazel Crest, IL 60429-1318
Phone (708) 803-1126
Other names 1
- Quintet Moore
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rxm.05055@store.walgreens.com | 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 |
|---|---|---|---|
| 049243907 | IL | MD | Community/Retail Pharmacy |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Community/Retail Pharmacy | Past | Accepting new patients |
Organizations & group practices 1
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": "1613606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613606400000",
"number": "1346833407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16820 TRAPET AVE",
"city": "HAZEL CREST",
"state": "IL",
"postal_code": "604291318",
"telephone_number": "708-803-1126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12290 S PULASKI RD",
"city": "ALSIP",
"state": "IL",
"postal_code": "608031405",
"telephone_number": "708-385-2006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKINLEY",
"first_name": "QUINTET",
"middle_name": "NYESSIE",
"credential": "CPHT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-18",
"last_updated": "2021-02-18",
"certification_date": "2021-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "IL",
"license": "049243907",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rxm.05055@store.walgreens.com",
"affiliation": "N",
"endpointDescription": "store email",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "12290 S Pulaski Rd",
"city": "Alsip",
"state": "IL",
"country_code": "US",
"postal_code": "608031405",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "QUINTET",
"last_name": "MOORE",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Alsip, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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.