Active NPI
Daniel Tavares, PHARMD
- Pharmacist
- Moodus, CT
National Provider Identifier
1528552197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PCT.0012072
- Practice address
- 26 Falls Rd
Moodus, CT 06469-1262 - Phone
- (860) 367-4773
- NPI assigned
- Jun 18, 2018
- Last updated
- Jan 27, 2020
- 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 | PCT.0012072 | CT | Primary |
Addresses
Primary practice location
26 Falls Rd
Moodus, CT 06469-1262
Mailing address
12 Keyboard LN
Ivoryton, CT 06442-1265
Phone (860) 367-4773
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 |
|---|---|---|---|
| PCT.0012072 | CT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Ray Pharmacy LLC | Current | Accepting new patients | |
| Frederick Ray Pharmacy LLC | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Long Term Care Pharmacy
- Moodus, CT
- NPI 1093340820
-
- Pharmacy
- Moodus, CT
- NPI 1487298782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580083200000",
"number": "1528552197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 KEYBOARD LN",
"city": "IVORYTON",
"state": "CT",
"postal_code": "064421265",
"telephone_number": "860-367-4773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 FALLS RD",
"city": "MOODUS",
"state": "CT",
"postal_code": "064691262",
"telephone_number": "860-367-4773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVARES",
"first_name": "DANIEL",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-18",
"last_updated": "2020-01-27",
"certification_date": "2020-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CT",
"license": "PCT.0012072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moodus, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.