Active NPI
Michael Ray Moore, CPHT
- Pharmacy Technician
- Brookline, MA
National Provider Identifier
1760081533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- PHA-PTE-LIC-83395
- Practice address
- 179 Kent St
Brookline, MA 02446-5463 - Phone
- (617) 299-9131
- NPI assigned
- Oct 22, 2020
- Last updated
- Jun 26, 2024
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 39282 | TN | |
| Pharmacy Technician | 183700000X | VA61082215 | WA | |
| Pharmacy Technician | 183700000X | PHA-PTE-LIC-83395 | MT | Primary |
Addresses
Primary practice location
179 Kent St
Brookline, MA 02446-5463
Mailing address
179 Kent St
Brookline, MA 02446-5463
Phone (617) 299-9131
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 |
|---|---|---|---|
| PHA-PTE-LIC-83395 | MT | MD | Pharmacy Technician |
| VA61082215 | WA | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Washington CVS Pharmacy 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719360000000",
"number": "1760081533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "179 KENT ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024465463",
"telephone_number": "617-299-9131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 KENT ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024465463",
"telephone_number": "617-299-9131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MICHAEL",
"middle_name": "RAY",
"name_prefix": "Mr.",
"credential": "CPHT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-22",
"last_updated": "2024-06-26",
"certification_date": "2024-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "TN",
"license": "39282",
"primary": false
},
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "WA",
"license": "VA61082215",
"primary": false
},
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "MT",
"license": "PHA-PTE-LIC-83395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.