Individual provider Active NPI

Sean Matthew Ogle, RPH

  • Pharmacist
  • Port Jefferson Station, NY
National Provider Identifier
1730689001
Registry record updated Jul 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
063858 Issued in NY
Practice address
1110 Route 112
Port Jefferson Station, NY 11776
Phone
(631) 474-2657
NPI assigned
Feb 13, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PCT.0014380 CT
Pharmacist 183500000X 063858 NY Primary

Addresses

Primary practice location

1110 Route 112
Port Jefferson Station, NY 11776

Mailing address

1110 Route 112
Port Jefferson Station, NY 11776-3236
Phone (631) 474-2657

Other practice location 1

1110 Route 112
Port Jefferson Station, NY 11776
Phone (631) 474-2657

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

LicenseStateTypeSpecialty
PCT.0014380CTMDPharmacist
063858NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthworld RX Inc Past Accepting new patients
CVS Albany LLC PastSince Jul 28, 2019 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1518480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563667200000",
    "number": "1730689001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763236",
            "telephone_number": "631-474-2657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-474-2657"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1110 Route 112",
            "address_purpose": "LOCATION",
            "city": "Port Jefferson Station",
            "state": "NY",
            "postal_code": "11776",
            "country_code": "US",
            "telephone_number": "631-474-2657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OGLE",
        "first_name": "SEAN",
        "middle_name": "MATTHEW",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-13",
        "last_updated": "2019-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CT",
            "license": "PCT.0014380",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "063858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2019; 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.