Individual provider Active NPI

Kirstie Mrzyglod

  • Pharmacist
  • Dallas, GA
National Provider Identifier
1992252472
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH029366 Issued in GA
Practice address
80 Seven Hills Blvd
Dallas, GA 30132-0574
Phone
(770) 975-6791
NPI assigned
Sep 1, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH029366 GA Primary

Addresses

Primary practice location

80 Seven Hills Blvd
Dallas, GA 30132-0574

Mailing address

166 Rock Garden Ter NW
Marietta, GA 30064-2622

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
RPH029366GAMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472688000000",
    "number": "1992252472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 ROCK GARDEN TER NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300642622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SEVEN HILLS BLVD",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301320574",
            "telephone_number": "770-975-6791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MRZYGLOD",
        "first_name": "KIRSTIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH029366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.