Active NPI
Kevin Moore
- Pharmacist
- Gainesville, FL
National Provider Identifier
1700486024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS40079
- Practice address
- 4001 SW 30TH PL
Gainesville, FL 32608-1907 - Phone
- (352) 339-7937
- Fax
- (352) 339-7922
- NPI assigned
- Oct 27, 2020
- 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 | PS40079 | FL | Primary |
Addresses
Primary practice location
4001 SW 30TH PL
Gainesville, FL 32608-1907
Mailing address
9517 SW 40TH LN
Gainesville, FL 32608-4647
Phone (352) 256-4304
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS40079 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1700486024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9517 SW 40TH LN",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326084647",
"telephone_number": "352-256-4304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 SW 30TH PL",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326081907",
"telephone_number": "352-339-7937",
"fax_number": "352-339-7922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "KEVIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-27",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS40079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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.