Active NPI
Lynn G Wiltrakis, RPH.
- Pharmacist
- Griffith, IN
National Provider Identifier
1043591092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26016285A
- Practice address
- 407 W Glen Park Ave
Griffith, IN 46319-1511 - Phone
- (219) 924-2703
- NPI assigned
- Sep 5, 2011
- 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 | 26016285A | IN | Primary |
Addresses
Primary practice location
407 W Glen Park Ave
Griffith, IN 46319-1511
Mailing address
12115 W 95TH PL
Saint John, IN 46373-9537
Phone (219) 365-3135
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26016285A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315180800000",
"number": "1043591092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12115 W 95TH PL",
"city": "SAINT JOHN",
"state": "IN",
"postal_code": "463739537",
"telephone_number": "219-365-3135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 W GLEN PARK AVE",
"city": "GRIFFITH",
"state": "IN",
"postal_code": "463191511",
"telephone_number": "219-924-2703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILTRAKIS",
"first_name": "LYNN",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "RPH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-05",
"last_updated": "2011-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26016285A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Griffith, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 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.