Active NPI
Kyle Matala, RPH
- Pharmacist
- Raleigh, NC
National Provider Identifier
1609213099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15453
- Practice address
- 14520 John Rex Blvd
Raleigh, NC 27614-8592 - Phone
- (919) 909-6375
- NPI assigned
- May 27, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 | 15453 | NC | Primary |
Addresses
Primary practice location
14520 John Rex Blvd
Raleigh, NC 27614-8592
Mailing address
14520 John Rex Blvd
Raleigh, NC 27614-8592
Phone (919) 909-6375
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 |
|---|---|---|---|
| 15453 | NC | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harris Teeter LLC | Past | Accepting new patients |
Organizations & group practices 1
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": "1369612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369612800000",
"number": "1609213099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14520 JOHN REX BLVD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276148592",
"telephone_number": "919-909-6375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14520 JOHN REX BLVD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276148592",
"telephone_number": "919-909-6375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATALA",
"first_name": "KYLE",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-05-27",
"last_updated": "2013-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "15453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.