Active NPI
Jo Ellen Lusardi, RPH
- Pharmacist
- Green Bay, WI
National Provider Identifier
1073898193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12476-40
- Practice address
- 1401 E Mason St
Green Bay, WI 54301-3330 - Phone
- (920) 435-7679
- Fax
- (920) 435-0591
- NPI assigned
- Oct 20, 2011
- Sex
- Female
- 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 | 12476-40 | WI | Primary |
Addresses
Primary practice location
1401 E Mason St
Green Bay, WI 54301-3330
Mailing address
1401 E Mason St
Green Bay, WI 54301-3330
Phone (920) 435-7679
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5302027002 | Other | MI | REGISTERED PHARMACIST |
| 12476-040 | Other | WI | REGISTERED PHARMACIST |
Other names 1
- Jo Ellen Smiltneck
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 |
|---|---|---|---|
| 12476-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319068800000",
"number": "1073898193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 E MASON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543013330",
"telephone_number": "920-435-7679",
"fax_number": "920-435-0591"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 E MASON ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543013330",
"telephone_number": "920-435-7679",
"fax_number": "920-435-0591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUSARDI",
"first_name": "JO",
"middle_name": "ELLEN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-20",
"last_updated": "2011-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "12476-40",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED PHARMACIST",
"identifier": "5302027002",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED PHARMACIST",
"identifier": "12476-040",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JO",
"last_name": "SMILTNECK",
"middle_name": "ELLEN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Green Bay, WI
- Rolf Smart Lulloff, MD
- Sarah Jane Lulloff, MD
- Eric John Lund, PSY.D, BCBA-D, AND A
- Maria Jean Lundin, LPC-IT
- Mara Lungay, CRNA
- Erin Luttschwager, MA, LPC, NCC
- Luxottica of America Inc (Target Optical #1984)
- Luxottica of America Inc. (Lenscrafters #1327)
- Luxottica Retail North America Inc (Pearle Vision #6269)
- Nouteng Ly, ATC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.