Individual provider Active NPI

Rhett R Koski

  • Pharmacist
  • Fond Du Lac, WI
National Provider Identifier
1083990907
Registry record updated Oct 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
14348-40 Issued in WI
Practice address
20 W Pioneer Rd
Fond Du Lac, WI 54935-6152
Phone
(920) 907-0556
Fax
(920) 907-0639
NPI assigned
Oct 24, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 14348-40 WI Primary

Addresses

Primary practice location

20 W Pioneer Rd
Fond Du Lac, WI 54935-6152

Mailing address

20 W Pioneer Rd
Fond Du Lac, WI 54935-6152
Phone (920) 907-0556

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

LicenseStateTypeSpecialty
14348-40WIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co PastSince Mar 20, 2022 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": "1319414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319414400000",
    "number": "1083990907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 W PIONEER RD",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549356152",
            "telephone_number": "920-907-0556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 W PIONEER RD",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549356152",
            "telephone_number": "920-907-0556",
            "fax_number": "920-907-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSKI",
        "first_name": "RHETT",
        "middle_name": "R",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-24",
        "last_updated": "2011-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "14348-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.

Verify at the official NPI Registry.