Active NPI
John Grossman, PHARMD
- Pharmacist
- Kenosha, WI
National Provider Identifier
1043054927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22581-40
- Practice address
- 2207 80TH St
Kenosha, WI 53143-5756 - Phone
- (262) 658-3731
- NPI assigned
- Jun 24, 2024
- Last updated
- Jun 24, 2024
- 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 | 22581-40 | WI | Primary |
Addresses
Primary practice location
2207 80TH St
Kenosha, WI 53143-5756
Mailing address
1426 N Bridgeport Dr
Mount Prospect, IL 60056-1002
Phone (847) 322-4293
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22581-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients | |
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719187200000",
"number": "1043054927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1426 N BRIDGEPORT DR",
"city": "MOUNT PROSPECT",
"state": "IL",
"postal_code": "600561002",
"telephone_number": "847-322-4293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2207 80TH ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435756",
"telephone_number": "262-658-3731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSSMAN",
"first_name": "JOHN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-24",
"last_updated": "2024-06-24",
"certification_date": "2024-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "22581-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.