Tony Kong Moua, PHD

Primary specialty

PharmacistTaxonomy code 183500000X

License

124929 Issued in MN

Practice address

4800 Highway 61 N
White Bear Lake, MN 55110-2844

Phone

(651) 762-3864

NPI assigned

Dec 1, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grand St Paul CVS LLC

  • Pharmacy
  • Plymouth, MN
  • NPI 1437620903
  NPD (past)
• Grand St Paul CVS LLC

  • Pharmacy
  • White Bear Lake, MN
  • NPI 1972602274
  NPD (past)

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1366047235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3480 ENGLISH ST",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105204",
            "telephone_number": "651-230-7857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 HIGHWAY 61 N",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102844",
            "telephone_number": "651-762-3864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUA",
        "first_name": "TONY",
        "middle_name": "KONG",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "124929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Pharmacist",
            "affiliation": "N",
            "endpointDescription": "Pharmacy",
            "address_1": "4800 Highway 61 N",
            "city": "White Bear Lake",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551102844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• James G Mondo, D.C.
• Mitchel Vincent Mondo, D.C.
• Mackenzie Monty
• Michele Moore, MN CHID #2729
• Jason Moua, RPH
• Twyla Dara Annapurna Marjo Mowll
• Chester Mulholland, LPCC
• Grace Louise Murphy, MD
• My Home Health Care, Inc.
• Patrick Girard Napoli, D.C.

• All providers in White Bear Lake, MN
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.

Verify at the official NPI Registry.