NPIMap

Individual provider Active NPI

Alonzo Moore

  • Pharmacist
  • Sacramento, CA
National Provider Identifier
1962813642
Registry record updated May 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
30162 Issued in CA
Practice address
4850 Freeport Blvd
Sacramento, CA 95822-2102
Phone
(916) 452-3811
Fax
(916) 452-5958
NPI assigned
May 15, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 30162 CA Primary

Addresses

Primary practice location

4850 Freeport Blvd
Sacramento, CA 95822-2102

Mailing address

4850 Freeport Blvd
Sacramento, CA 95822-2102
Phone (916) 452-3811

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

LicenseStateTypeSpecialty
30162CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Raleys Past Accepting new patients
Raleys 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1400112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1962813642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 FREEPORT BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958222102",
            "telephone_number": "916-452-3811",
            "fax_number": "916-452-5958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 FREEPORT BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958222102",
            "telephone_number": "916-452-3811",
            "fax_number": "916-452-5958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ALONZO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-15",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "30162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; 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.