Active NPI
Stacy Moon, PHARMD
- Pharmacist
- Skokie, IL
National Provider Identifier
1710552930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 51.496445
- Practice address
- 9449 Skokie Blvd
Skokie, IL 60077-1317 - Phone
- (847) 677-2564
- Fax
- (847) 677-3450
- NPI assigned
- May 20, 2021
- Last updated
- May 20, 2021
- Sex
- Female
- 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 | 51.496445 | IL | Primary |
Addresses
Primary practice location
9449 Skokie Blvd
Skokie, IL 60077-1317
Mailing address
9449 Skokie Blvd
Skokie, IL 60077-1317
Phone (847) 677-2564
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 |
|---|---|---|---|
| 51.496445 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Drug Stores LLC | Past | Accepting new patients | |
| American Drug Stores LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Retail Pharmacy
- Diamond, IL
- NPI 1013786706
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621468800000",
"number": "1710552930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9449 SKOKIE BLVD",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600771317",
"telephone_number": "847-677-2564",
"fax_number": "847-677-3450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9449 SKOKIE BLVD",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600771317",
"telephone_number": "847-677-2564",
"fax_number": "847-677-3450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "STACY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-20",
"last_updated": "2021-05-20",
"certification_date": "2021-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "51.496445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.