Active NPI
Dona Marie Idt, CPHT
- Pharmacy Technician
- Grafton, WI
National Provider Identifier
1033509500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 590107010293680
- Practice address
- 1250 N Port Washington Rd
Grafton, WI 53024-9315 - Phone
- (262) 375-6738
- Fax
- (262) 618-9138
- NPI assigned
- Feb 4, 2015
- Last updated
- Feb 4, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 590107010293680 | WI | Primary |
Addresses
Primary practice location
1250 N Port Washington Rd
Grafton, WI 53024-9315
Mailing address
1250 N Port Washington Rd
Grafton, WI 53024-9315
Phone (262) 375-6738
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 |
|---|---|---|---|
| 590107010293680 | WI | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423008000000",
"number": "1033509500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1250 N PORT WASHINGTON RD",
"city": "GRAFTON",
"state": "WI",
"postal_code": "530249315",
"telephone_number": "262-375-6738",
"fax_number": "262-618-9138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 N PORT WASHINGTON RD",
"city": "GRAFTON",
"state": "WI",
"postal_code": "530249315",
"telephone_number": "262-375-6738",
"fax_number": "262-618-9138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IDT",
"first_name": "DONA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "CPHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-04",
"last_updated": "2015-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "WI",
"license": "590107010293680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grafton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.