Active NPI
Richard Donald Moe, RPH
- Pharmacist
- Superior, WI
National Provider Identifier
1396068490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11924-040
- Practice address
- 2631 Tower Ave
Superior, WI 54880-4846 - Phone
- (715) 392-0487
- Fax
- (175) 392-1754
- NPI assigned
- Mar 4, 2010
- Sex
- Male
- Sole proprietor
- No
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 | 11924-040 | WI | Primary |
Addresses
Primary practice location
2631 Tower Ave
Superior, WI 54880-4846
Mailing address
2631 Tower Ave
Superior, WI 54880-4846
Phone (715) 392-0487
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11924-040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients | |
| Wisconsin CVS Pharmacy LLC | 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": "1267660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374192000000",
"number": "1396068490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2631 TOWER AVE",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548804846",
"telephone_number": "715-392-0487",
"fax_number": "175-392-1754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2631 TOWER AVE",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548804846",
"telephone_number": "715-392-0487",
"fax_number": "175-392-1754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOE",
"first_name": "RICHARD",
"middle_name": "DONALD",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-04",
"last_updated": "2013-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "11924-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Superior, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.