Individual provider Active NPI

Darrin D Wirkes, R.PH.

  • Pharmacist
  • Green Bay, WI
National Provider Identifier
1104110477
Registry record updated Nov 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
11915-40 Issued in WI
Practice address
2585 Lineville Rd
Shopko Express #502
Green Bay, WI 54313-7122
Phone
(920) 662-9450
Fax
(920) 662-1912
NPI assigned
Jun 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 11915-40 WI Primary

Addresses

Primary practice location

2585 Lineville Rd
Shopko Express #502
Green Bay, WI 54313-7122

Mailing address

2585 Lineville Rd
Shopko Express #502
Green Bay, WI 54313-7122
Phone (920) 662-9450

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

LicenseStateTypeSpecialty
11915-40WIMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1307145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384992000000",
    "number": "1104110477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2585 LINEVILLE RD",
            "address_2": "SHOPKO EXPRESS #502",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137122",
            "telephone_number": "920-662-9450",
            "fax_number": "920-662-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2585 LINEVILLE RD",
            "address_2": "SHOPKO EXPRESS #502",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137122",
            "telephone_number": "920-662-9450",
            "fax_number": "920-662-1912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRKES",
        "first_name": "DARRIN",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-04",
        "last_updated": "2013-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "11915-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; 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.