Active NPI
James Kenneth McKenna-Mantica, PHARM. D, RPH
- Pharmacist
- Albany, NY
National Provider Identifier
1841680428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 033.0096278
- Practice address
- 709 Central Ave
Albany, NY 12206-1604 - Phone
- (518) 292-1250
- NPI assigned
- Feb 3, 2015
- Last updated
- Feb 4, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 059979 | NY | |
| Pharmacist | 183500000X | 033.0096278 | VT | Primary |
Addresses
Primary practice location
709 Central Ave
Albany, NY 12206-1604
Mailing address
709 Central Ave
Albany, NY 12206-1604
Phone (518) 292-1250
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 059979 | Other | NY | NYS PHARMACIST LICENSE NUMBER |
| 033.0096278 | Other | VT | VT PHARMACIST LICENSE NUMBER |
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, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 059979 | NY | MD | General Practice Dentistry |
| 033.0096278 | VT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoprite Supermarkets, Inc | 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.
-
dba Shoprite Pharmacy of Monticello
- Community/Retail Pharmacy
- Monticello, NY
- NPI 1508971383
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423008000000",
"number": "1841680428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 CENTRAL AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "122061604",
"telephone_number": "518-292-1250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 CENTRAL AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "122061604",
"telephone_number": "518-292-1250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENNA-MANTICA",
"first_name": "JAMES",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "PHARM. D, RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-02-03",
"last_updated": "2015-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "059979",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VT",
"license": "033.0096278",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NYS PHARMACIST LICENSE NUMBER",
"identifier": "059979",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VT PHARMACIST LICENSE NUMBER",
"identifier": "033.0096278",
"state": "VT"
}
],
"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 Feb 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.