Active NPI
Gary L Kracoff, REG. PHARM, NMD
- Pharmacist
- Waltham, MA
National Provider Identifier
1497934194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17262
- Practice address
- 577 Main St
Waltham, MA 02452-5527 - Phone
- (781) 893-3870
- NPI assigned
- Oct 30, 2007
- 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 | 17262 | MA | Primary |
Addresses
Primary practice location
577 Main St
Waltham, MA 02452-5527
Mailing address
577 Main St
Waltham, MA 02452-5527
Phone (781) 893-3870
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17262 | MA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193702400000",
"number": "1497934194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "577 MAIN ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024525527",
"telephone_number": "781-893-3870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "577 MAIN ST",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024525527",
"telephone_number": "781-893-3870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRACOFF",
"first_name": "GARY",
"middle_name": "L",
"credential": "REG. PHARM, NMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-30",
"last_updated": "2007-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "17262",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.