NPIMap

Individual provider Active NPI

Kevin Alan Moll, RPH

  • Pharmacist
  • Salem, OR
National Provider Identifier
1376853515
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
8292 Issued in OR
Practice address
1992 Lancaster Dr NE
Salem, OR 97305
Phone
(503) 362-4845
NPI assigned
Oct 20, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 8292 OR Primary
Pharmacist 183500000X 9517 AZ

Addresses

Primary practice location

1992 Lancaster Dr NE
Salem, OR 97305

Mailing address

1992 Lancaster Dr NE
Salem, OR 97305
Phone (503) 362-4845

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
9517AZMDPharmacist
8292ORMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287532800000",
    "number": "1376853515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1992 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97305",
            "telephone_number": "503-362-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1992 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97305",
            "telephone_number": "503-362-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLL",
        "first_name": "KEVIN",
        "middle_name": "ALAN",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-20",
        "last_updated": "2010-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "8292",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "9517",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; 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.