Active NPI
Daniel Wilder, CPHT
- Pharmacy Technician
- East Peoria, IL
National Provider Identifier
1104569268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 049.278851
- Practice address
- 300 N Main St
East Peoria, IL 61611-2081 - Phone
- (309) 694-7661
- NPI assigned
- Apr 18, 2022
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 049.278851 | IL | Primary |
Addresses
Primary practice location
300 N Main St
East Peoria, IL 61611-2081
Mailing address
1011 Peoria St
Washington, IL 61571-2487
Phone (309) 444-1681
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
| License | State | Type | Specialty |
|---|---|---|---|
| 049.278851 | IL | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738627200000",
"number": "1104569268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 PEORIA ST",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615712487",
"telephone_number": "309-444-1681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N MAIN ST",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616112081",
"telephone_number": "309-694-7661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "DANIEL",
"name_prefix": "Mr.",
"credential": "CPHT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-18",
"last_updated": "2025-02-04",
"certification_date": "2025-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "IL",
"license": "049.278851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.