Active NPI
Eltona Moni
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1366712580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302035770
- Practice address
- 2650 Atwater Hills Dr NE
Grand Rapids, MI 49525-9456 - Phone
- (616) 361-0455
- NPI assigned
- Jan 4, 2012
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302035770 | MI | Primary |
Addresses
Primary practice location
2650 Atwater Hills Dr NE
Grand Rapids, MI 49525-9456
Mailing address
2650 Atwater Hills Dr NE
Grand Rapids, MI 49525-9456
Phone (616) 361-0455
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 |
|---|---|---|---|
| 5302035770 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325635200000",
"number": "1366712580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2650 ATWATER HILLS DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495259456",
"telephone_number": "616-361-0455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 ATWATER HILLS DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495259456",
"telephone_number": "616-361-0455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONI",
"first_name": "ELTONA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-04",
"last_updated": "2012-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302035770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.