Active NPI
Nicole Wendt
- Pharmacist
- Mesa, AZ
National Provider Identifier
1073128765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S024852
- Practice address
- 1130 W Southern Ave
Mesa, AZ 85210-4993 - Phone
- (480) 461-1193
- NPI assigned
- Sep 10, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | S024852 | AZ | Primary |
Addresses
Primary practice location
1130 W Southern Ave
Mesa, AZ 85210-4993
Mailing address
1130 W Southern Ave
Mesa, AZ 85210-4993
Phone (480) 461-1193
Other practice location 1
805 S Val Vista Dr
Gilbert, AZ 85296-3788
Phone (480) 892-6039
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 |
|---|---|---|---|
| S024852 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1130 W Southern Ave
Mesa, AZ 85210
Phone (480) 461-1193
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": "1599696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657756800000",
"number": "1073128765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1130 W SOUTHERN AVE",
"city": "MESA",
"state": "AZ",
"postal_code": "852104993",
"telephone_number": "480-461-1193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 W SOUTHERN AVE",
"city": "MESA",
"state": "AZ",
"postal_code": "852104993",
"telephone_number": "480-461-1193"
}
],
"practiceLocations": [
{
"address_1": "805 S Val Vista Dr",
"address_purpose": "LOCATION",
"city": "Gilbert",
"state": "AZ",
"postal_code": "852963788",
"country_code": "US",
"telephone_number": "480-892-6039",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WENDT",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-10",
"last_updated": "2022-07-14",
"certification_date": "2022-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S024852",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.