Active NPI
Jonathan William Strom, RPH
- Pharmacist
- Green Bay, WI
National Provider Identifier
1063423200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12561040
- Practice address
- 744 South Webster Ave
Green Bay, WI 54307-3400 - Phone
- (920) 431-5696
- Fax
- (920) 431-5677
- NPI assigned
- Aug 11, 2006
- Last updated
- Jul 8, 2007
- 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 | 12561040 | WI | Primary |
Addresses
Primary practice location
744 South Webster Ave
Green Bay, WI 54307-3400
Mailing address
2987 Fleetwood Dr
Green Bay, WI 54313
Phone (920) 431-9006
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33233700 | Medicaid | WI | |
| 5124689 | Other | NCPDP |
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 |
|---|---|---|---|
| 12561040 | WI | MD | Pharmacist |
Organizations & group practices 3
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.
-
dba Bellin Health Pharmacy
- Community/Retail Pharmacy
- Green Bay, WI
- NPI 1386800597
-
- Clinic Pharmacy
- Wrightstown, WI
- NPI 1700174760
-
dba Bellin Health Remote Dispensing
- Community/Retail Pharmacy
- Green Bay, WI
- NPI 1235486028
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063423200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2987 FLEETWOOD DR",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "54313",
"telephone_number": "920-431-9006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "744 SOUTH WEBSTER AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543073400",
"telephone_number": "920-431-5696",
"fax_number": "920-431-5677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STROM",
"first_name": "JONATHAN",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "12561040",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33233700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "5124689",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.