Lars E Vardaman, PHARM D

Primary specialty

PharmacistTaxonomy code 183500000X

License

051.294476 Issued in IL

Practice address

6525 N Illinois St
Fairview Heights, IL 62208-2001

Phone

(618) 397-2091

Fax

(618) 397-2187

NPI assigned

Feb 27, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1013281823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6525 N ILLINOIS ST",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082001",
            "telephone_number": "618-397-2091",
            "fax_number": "618-397-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 N ILLINOIS ST",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082001",
            "telephone_number": "618-397-2091",
            "fax_number": "618-397-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARDAMAN",
        "first_name": "LARS",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-27",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.294476",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2010026072",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2012; 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.