Active NPI
Valery Mbah, PHARMD
- Pharmacist
- Lincolnwood, IL
National Provider Identifier
1992300859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051298913
- Practice address
- 3950 W Devon Ave
Lincolnwood, IL 60712-1043 - Phone
- (847) 763-0685
- NPI assigned
- Nov 30, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 051298913 | IL | Primary |
Addresses
Primary practice location
3950 W Devon Ave
Lincolnwood, IL 60712-1043
Mailing address
3950 W Devon Ave
Lincolnwood, IL 60712-1043
Phone (847) 763-0685
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rx08749@stores.cvs.com |
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 |
|---|---|---|---|
| 051298913 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS LLC | 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.
-
- Pharmacy
- Lincolnwood, IL
- NPI 1215978135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606694400000",
"number": "1992300859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3950 W DEVON AVE",
"city": "LINCOLNWOOD",
"state": "IL",
"postal_code": "607121043",
"telephone_number": "847-763-0685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3950 W DEVON AVE",
"city": "LINCOLNWOOD",
"state": "IL",
"postal_code": "607121043",
"telephone_number": "847-763-0685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MBAH",
"first_name": "VALERY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-30",
"last_updated": "2020-11-30",
"certification_date": "2020-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051298913",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rx08749@stores.cvs.com",
"affiliation": "N",
"address_1": "3950 W Devon Ave",
"city": "Lincolnwood",
"state": "IL",
"country_code": "US",
"postal_code": "607121043",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Lincolnwood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.