Active NPI
Jacob Thomas Lilletvedt, PHARMACIST
- Pharmacist
- Miles City, MT
National Provider Identifier
1013574441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PHA-PHA-LIC-55429
- Practice address
- 519 S Haynes Ave
Miles City, MT 59301-4768 - Phone
- (406) 232-4627
- NPI assigned
- May 21, 2019
- 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 | PHA-PHA-LIC-55429 | MT | Primary |
Addresses
Primary practice location
519 S Haynes Ave
Miles City, MT 59301-4768
Mailing address
315 Charles St Apt 28
Miles City, MT 59301-4158
Phone (406) 262-3515
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
| License | State | Type | Specialty |
|---|---|---|---|
| PHA-PHA-LIC-55429 | MT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558396800000",
"number": "1013574441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "315 CHARLES ST APT 28",
"city": "MILES CITY",
"state": "MT",
"postal_code": "593014158",
"telephone_number": "406-262-3515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "519 S HAYNES AVE",
"city": "MILES CITY",
"state": "MT",
"postal_code": "593014768",
"telephone_number": "406-232-4627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLETVEDT",
"first_name": "JACOB",
"middle_name": "THOMAS",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-21",
"last_updated": "2019-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MT",
"license": "PHA-PHA-LIC-55429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miles City, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.