Active NPI
Matthew Eugene Kellogg, PHARMD
- Pharmacist
- Corry, PA
National Provider Identifier
1942923990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP451245
- Practice address
- 330 W Columbus Ave
Corry, PA 16407-1002 - Phone
- (814) 664-2617
- NPI assigned
- Sep 23, 2022
- Last updated
- Sep 23, 2022
- 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 | RP451245 | PA | Primary |
Addresses
Primary practice location
330 W Columbus Ave
Corry, PA 16407-1002
Mailing address
609 Spring St
Corry, PA 16407-2115
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 |
|---|---|---|---|
| RP451245 | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pennsylvania CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Pennsylvania CVS Pharmacy, L.L.C. | 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": "1663891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663891200000",
"number": "1942923990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "609 SPRING ST",
"city": "CORRY",
"state": "PA",
"postal_code": "164072115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 W COLUMBUS AVE",
"city": "CORRY",
"state": "PA",
"postal_code": "164071002",
"telephone_number": "814-664-2617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLOGG",
"first_name": "MATTHEW",
"middle_name": "EUGENE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-23",
"last_updated": "2022-09-23",
"certification_date": "2022-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP451245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corry, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.