Active NPI
Howard John Mize, RPH
- Pharmacist
- Deforest, WI
National Provider Identifier
1013002930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 8946-040
- Practice address
- 639 S Main St
Suite 101
De Forest, WI 53532-1478 - Phone
- (608) 846-2712
- NPI assigned
- Oct 4, 2006
- Last updated
- Jul 8, 2007
- 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 | 8946-040 | WI | Primary |
Addresses
Primary practice location
639 S Main St
Suite 101
De Forest, WI 53532-1478
Mailing address
3745 Sequioa Trail
Verona, WI 53593
Phone (608) 798-1315
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33266000 | Medicaid | WI |
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8946-040 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013002930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3745 SEQUIOA TRAIL",
"city": "VERONA",
"state": "WI",
"postal_code": "53593",
"telephone_number": "608-798-1315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 S MAIN ST",
"address_2": "SUITE 101",
"city": "DE FOREST",
"state": "WI",
"postal_code": "535321478",
"telephone_number": "608-846-2712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIZE",
"first_name": "HOWARD",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "8946-040",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33266000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Deforest, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.