Individual provider Active NPI

Danielle Breann Moomaw, PHARMD

  • Pharmacist
  • Clinton Township, MI
National Provider Identifier
1912685959
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302411876 Issued in MI
Practice address
40445 S Groesbeck Hwy
Clinton Township, MI 48036-5005
Phone
(586) 239-7010
Fax
(586) 239-7065
NPI assigned
Jul 10, 2023
Last updated
Jul 10, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302411876 MI Primary

Addresses

Primary practice location

40445 S Groesbeck Hwy
Clinton Township, MI 48036-5005

Mailing address

40445 S Groesbeck Hwy
Clinton Township, MI 48036-5005
Phone (586) 239-7010

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
5302411876MIMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1912685959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40445 S GROESBECK HWY",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480365005",
            "telephone_number": "586-239-7010",
            "fax_number": "586-239-7065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40445 S GROESBECK HWY",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480365005",
            "telephone_number": "586-239-7010",
            "fax_number": "586-239-7065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOMAW",
        "first_name": "DANIELLE",
        "middle_name": "BREANN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302411876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.

Verify at the official NPI Registry.