NPIMap

Organization Active NPI

Walter Lagestee Incorporated

Doing business as Walt's Pharmacy #5

  • Community/Retail Pharmacy
  • Dyer, IN
National Provider Identifier
1073698023
Registry record updated Nov 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
60005711A Issued in IN
Legal business name
WALTER LAGESTEE INCORPORATED
Doing business as
Walt's Pharmacy #5
Practice address
1218 Sheffield Ave
Dyer, IN 46311-1053
Phone
(219) 865-4363
Fax
(219) 865-4365
NPI assigned
Oct 26, 2006
Last updated
Nov 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Patrick J Egan, PHARMACISTNPI 1649325325
Title
Third Party Coordinator
Phone
(708) 957-2974

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 60005711A IN Primary

Addresses

Primary practice location

1218 Sheffield Ave
Dyer, IN 46311-1053

Mailing address

1218 Sheffield Ave
Dyer, IN 46311-1053
Phone (219) 865-4363

Other identifiers 1

IdentifierTypeStateIssuer
200422800MedicaidIN

Other names 1

  • Walt's Pharmacy #5 Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353024000000",
    "number": "1073698023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 SHEFFIELD AVE",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111053",
            "telephone_number": "219-865-4363",
            "fax_number": "219-865-4365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 SHEFFIELD AVE",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111053",
            "telephone_number": "219-865-4363",
            "fax_number": "219-865-4365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER LAGESTEE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2012-11-16",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "THIRD PARTY COORDINATOR",
        "authorized_official_telephone_number": "708-957-2974",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60005711A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200422800",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walt's Pharmacy #5",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dyer, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.