Active NPI
Kevin J Reilly, PHARM.D.
- Pharmacist
- De Witt, IA
National Provider Identifier
1073658910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18854
- Practice address
- 629 6TH Ave
De Witt, IA 52742-1635 - Phone
- (563) 659-5042
- NPI assigned
- Feb 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 18854 | IA | Primary |
Addresses
Primary practice location
629 6TH Ave
De Witt, IA 52742-1635
Mailing address
711 N 1St St
Apt. C207
Eldridge, IA 52748-1287
Phone (319) 290-7605
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 |
|---|---|---|---|
| 18854 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073658910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 N 1ST ST",
"address_2": "APT. C207",
"city": "ELDRIDGE",
"state": "IA",
"postal_code": "527481287",
"telephone_number": "319-290-7605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "629 6TH AVE",
"city": "DE WITT",
"state": "IA",
"postal_code": "527421635",
"telephone_number": "563-659-5042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILLY",
"first_name": "KEVIN",
"middle_name": "J",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "18854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in De Witt, IA
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.