Active NPI
Moumita Datta
- Pharmacist
- Highland Park, MI
National Provider Identifier
1891077954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302039801
- Practice address
- 14048 Woodward Ave
Highland Park, MI 48203-3629 - Phone
- (313) 869-2177
- NPI assigned
- Sep 14, 2011
- Sex
- Female
- 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 | 5302039801 | MI | Primary |
Addresses
Primary practice location
14048 Woodward Ave
Highland Park, MI 48203-3629
Mailing address
5634 Fordham Cir Apt 204
Canton, MI 48187-3353
Phone (734) 981-1707
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 |
|---|---|---|---|
| 5302039801 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315958400000",
"number": "1891077954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5634 FORDHAM CIR APT 204",
"city": "CANTON",
"state": "MI",
"postal_code": "481873353",
"telephone_number": "734-981-1707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14048 WOODWARD AVE",
"city": "HIGHLAND PARK",
"state": "MI",
"postal_code": "482033629",
"telephone_number": "313-869-2177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DATTA",
"first_name": "MOUMITA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-14",
"last_updated": "2011-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302039801",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Highland Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.