Active NPI
Kelli Paulson
- Pharmacist
- Berwyn, IL
National Provider Identifier
1114208204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051290333
- Practice address
- 6800 Ogden Ave
Berwyn, IL 60402-3643 - Phone
- (170) 874-9906
- NPI assigned
- Sep 1, 2011
- Last updated
- Sep 1, 2011
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051290333 | IL | Primary |
Addresses
Primary practice location
6800 Ogden Ave
Berwyn, IL 60402-3643
Mailing address
1111 Burlington Ave Unit 403
Lisle, IL 60532-4525
Phone (630) 689-8756
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 |
|---|---|---|---|
| 051290333 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314835200000",
"number": "1114208204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 BURLINGTON AVE UNIT 403",
"city": "LISLE",
"state": "IL",
"postal_code": "605324525",
"telephone_number": "630-689-8756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6800 OGDEN AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023643",
"telephone_number": "170-874-9906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAULSON",
"first_name": "KELLI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-01",
"last_updated": "2011-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051290333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
- Rucha Patel
- Shachi Patel
- Demetrios Patos, D.C.
- Patriot Car Services, LLC
- Paul Potach D.P.M.,P.C. (Berwyn Foot & Ankle Center)
- Justin James Payette, D.P.T., C.S.C.S.
- Annette R Payot, CNM
- PCC Community Wellness Center (South Family Health Center)
- PCC Community Wellness Center (The Birth Center at PCC)
- Sharlyn Pech, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.