Active NPI
Robert Blake Brockwell
- Pharmacy Technician
- Danville, IL
National Provider Identifier
1023303682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 049.160038
- Practice address
- 22218 N 1750 East Rd
Danville, IL 61834-7456 - Phone
- (217) 260-0688
- NPI assigned
- Jun 12, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 087172 | NY | |
| Pharmacy Technician | 183700000X | 049.160038 | IL | Primary |
Addresses
Primary practice location
22218 N 1750 East Rd
Danville, IL 61834-7456
Mailing address
22218 N 1750 East Rd
Danville, IL 61834-7456
Phone (217) 260-0688
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 |
|---|---|---|---|
| 087172 | NY | MD | Pharmacist |
| 049.160038 | IL | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307836800000",
"number": "1023303682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22218 N 1750 EAST RD",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618347456",
"telephone_number": "217-260-0688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22218 N 1750 EAST RD",
"city": "DANVILLE",
"state": "IL",
"postal_code": "618347456",
"telephone_number": "217-260-0688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKWELL",
"first_name": "ROBERT",
"middle_name": "BLAKE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-12",
"last_updated": "2011-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "087172",
"primary": false
},
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "IL",
"license": "049.160038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.