Active NPI
Roberta Elise Marriott
- Pharmacy Technician
- Mount Carmel, IL
National Provider Identifier
1104960046
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- Practice address
- 1325 W 9TH St
Mount Carmel, IL 62863-2906 - Phone
- (618) 263-4543
- Fax
- (618) 262-5294
- NPI assigned
- Feb 16, 2007
- Sex
- Female
- Sole proprietor
- No
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 | IL | Primary |
Addresses
Primary practice location
1325 W 9TH St
Mount Carmel, IL 62863-2906
Mailing address
PO Box 416
Mount Carmel, IL 62863-0416
Phone (618) 240-1262
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 |
|---|---|---|---|
| 049128361 | IL | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104960046",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 416",
"city": "MOUNT CARMEL",
"state": "IL",
"postal_code": "628630416",
"telephone_number": "618-240-1262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 W 9TH ST",
"city": "MOUNT CARMEL",
"state": "IL",
"postal_code": "628632906",
"telephone_number": "618-263-4543",
"fax_number": "618-262-5294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARRIOTT",
"first_name": "ROBERTA",
"middle_name": "ELISE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Carmel, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.