Active NPI
Kerry Dean Mose, PHARM D.
- Pharmacist
- Broken Arrow, OK
National Provider Identifier
1780277996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13247
- Practice address
- 950 E Kenosha St
Broken Arrow, OK 74012-2071 - Phone
- (918) 251-3996
- NPI assigned
- Feb 18, 2021
- Last updated
- Feb 18, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 13247 | OK | Primary |
Addresses
Primary practice location
950 E Kenosha St
Broken Arrow, OK 74012-2071
Mailing address
11420 E 133Rd St S
Broken Arrow, OK 74011-5231
Phone (918) 636-6414
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613606400000",
"number": "1780277996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11420 E 133RD ST S",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740115231",
"telephone_number": "918-636-6414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 E KENOSHA ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740122071",
"telephone_number": "918-251-3996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSE",
"first_name": "KERRY",
"middle_name": "DEAN",
"credential": "PHARM D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-18",
"last_updated": "2021-02-18",
"certification_date": "2021-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "13247",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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.