Active NPI
Michelle Gosa
- Pharmacist
- Broadview, IL
National Provider Identifier
1114296415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051290167
- Practice address
- 2329 S 24TH Ave
Broadview, IL 60155-3822 - Phone
- (708) 223-8848
- NPI assigned
- Dec 16, 2011
- Last updated
- Jun 16, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051290167 | IL | Primary |
Addresses
Primary practice location
2329 S 24TH Ave
Broadview, IL 60155-3822
Mailing address
2329 S 24TH Ave
Broadview, IL 60155-3822
Phone (708) 223-8848
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 |
|---|---|---|---|
| 051290167 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1114296415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2329 S 24TH AVE",
"city": "BROADVIEW",
"state": "IL",
"postal_code": "601553822",
"telephone_number": "708-223-8848"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2329 S 24TH AVE",
"city": "BROADVIEW",
"state": "IL",
"postal_code": "601553822",
"telephone_number": "708-223-8848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOSA",
"first_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-16",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051290167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broadview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.