Active NPI
Gary L Rae, RPH
- Pharmacist
- Bolivar, MO
National Provider Identifier
1447840830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2007008323
- Practice address
- 2000 S Springfield Ave
Bolivar, MO 65613-9654 - Phone
- (417) 326-7455
- NPI assigned
- Jan 20, 2021
- 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 | 2007008323 | MO | Primary |
Addresses
Primary practice location
2000 S Springfield Ave
Bolivar, MO 65613-9654
Mailing address
2000 S Springfield Ave
Bolivar, MO 65613-9654
Phone (417) 326-7455
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538540406 | Medicaid | MO |
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 |
|---|---|---|---|
| 2007008323 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611100800000",
"number": "1447840830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 S SPRINGFIELD AVE",
"city": "BOLIVAR",
"state": "MO",
"postal_code": "656139654",
"telephone_number": "417-326-7455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 S SPRINGFIELD AVE",
"city": "BOLIVAR",
"state": "MO",
"postal_code": "656139654",
"telephone_number": "417-326-7455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAE",
"first_name": "GARY",
"middle_name": "L",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-20",
"last_updated": "2021-01-20",
"certification_date": "2021-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2007008323",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1538540406",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bolivar, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.