Individual provider Active NPI

Kirk Wade Myers, PHARM D

  • Pharmacist
  • Albany, NY
National Provider Identifier
1760778674
Registry record updated Jun 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
051111 Issued in NY
Practice address
350 Northern Blvd
Loudon Plaza
Albany, NY 12204-1000
Phone
(518) 257-7294
Fax
(518) 257-7299
NPI assigned
Jun 20, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 051111 NY Primary

Addresses

Primary practice location

350 Northern Blvd
Loudon Plaza
Albany, NY 12204-1000

Mailing address

350 Northern Blvd
Loudon Plaza
Albany, NY 12204-1000
Phone (518) 257-7294

Other identifiers 1

IdentifierTypeStateIssuer
02520056MedicaidNY

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
051111NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308528000000",
    "number": "1760778674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 NORTHERN BLVD",
            "address_2": "LOUDON PLAZA",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122041000",
            "telephone_number": "518-257-7294",
            "fax_number": "518-257-7299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 NORTHERN BLVD",
            "address_2": "LOUDON PLAZA",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122041000",
            "telephone_number": "518-257-7294",
            "fax_number": "518-257-7299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "KIRK",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "051111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02520056",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; 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.