Individual provider Active NPI

Steven F Moore, PHARM D.

  • Pharmacist
  • Plattsburgh, NY
National Provider Identifier
1730177817
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
050328 Issued in NY
Practice address
28 Montcalm Ave
Plattsburgh, NY 12901-1533
Phone
(518) 563-3400
Fax
(518) 563-5946
NPI assigned
Oct 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 28RJ02964500 NJ
Pharmacist 183500000X 050328 NY Primary

Addresses

Primary practice location

28 Montcalm Ave
Plattsburgh, NY 12901-1533

Mailing address

28 Montcalm Ave
Plattsburgh, NY 12901-1533
Phone (518) 563-3400

Other identifiers 1

IdentifierTypeStateIssuer
03248244MedicaidNY

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

LicenseStateTypeSpecialty
28RJ02964500NJMDPharmacist
050328NYMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1730177817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 MONTCALM AVE",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011533",
            "telephone_number": "518-563-3400",
            "fax_number": "518-563-5946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 MONTCALM AVE",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011533",
            "telephone_number": "518-563-3400",
            "fax_number": "518-563-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "STEVEN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "PHARM D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NJ",
            "license": "28RJ02964500",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "050328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03248244",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plattsburgh, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.