Active NPI
Shane Mouser, PHARM.D.
- Pharmacist
- Portland, TN
National Provider Identifier
1881076321
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 39160
- Practice address
- 705 S Broadway St
Portland, TN 37148-1628 - Phone
- (615) 323-5050
- Fax
- (615) 323-5052
- NPI assigned
- Jun 22, 2015
- Last updated
- Feb 9, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 39160 | TN | Primary |
Addresses
Primary practice location
705 S Broadway St
Portland, TN 37148-1628
Mailing address
503 Calista Rd
White House, TN 37188-9158
Phone (615) 681-1060
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
| License | State | Type | Specialty |
|---|---|---|---|
| 39160 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675900800000",
"number": "1881076321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 CALISTA RD",
"city": "WHITE HOUSE",
"state": "TN",
"postal_code": "371889158",
"telephone_number": "615-681-1060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 S BROADWAY ST",
"city": "PORTLAND",
"state": "TN",
"postal_code": "371481628",
"telephone_number": "615-323-5050",
"fax_number": "615-323-5052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUSER",
"first_name": "SHANE",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-22",
"last_updated": "2023-02-09",
"certification_date": "2023-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "39160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.