Active NPI
Vernon Eugene Andersen Jr., RPH
- Pharmacist
- Bethalto, IL
National Provider Identifier
1124340385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.029523
- Practice address
- 341 W Bethalto Dr
Bethalto, IL 62010-1779 - Phone
- (618) 377-5356
- Fax
- (618) 377-0159
- NPI assigned
- Feb 15, 2010
- Sex
- Male
- 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 | 051.029523 | IL | Primary |
Addresses
Primary practice location
341 W Bethalto Dr
Bethalto, IL 62010-1779
Mailing address
341 W Bethalto Dr
Bethalto, IL 62010-1779
Phone (618) 377-5356
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 364151335001 | Medicaid | IL |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 051.029523 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vernon Andersen Inc | Past | Accepting new patients | |
| 5 Guys RX LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Bethalto, IL
- NPI 1407867906
-
- Community/Retail Pharmacy
- Bethalto, IL
- NPI 1023464187
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266192000000",
"number": "1124340385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "341 W BETHALTO DR",
"city": "BETHALTO",
"state": "IL",
"postal_code": "620101779",
"telephone_number": "618-377-5356",
"fax_number": "618-377-0159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "341 W BETHALTO DR",
"city": "BETHALTO",
"state": "IL",
"postal_code": "620101779",
"telephone_number": "618-377-5356",
"fax_number": "618-377-0159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "VERNON",
"middle_name": "EUGENE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-15",
"last_updated": "2010-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.029523",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "364151335001",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethalto, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.