Active NPI
Dane Leist, PHARMD
- Pharmacist
- Two Rivers, WI
National Provider Identifier
1124396650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16249-040
- Practice address
- 2206 Washington St
Two Rivers, WI 54241-2241 - Phone
- (920) 793-8352
- NPI assigned
- Dec 12, 2011
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16249-040 | WI | Primary |
Addresses
Primary practice location
2206 Washington St
Two Rivers, WI 54241-2241
Mailing address
2206 Washington St
Two Rivers, WI 54241-2241
Phone (920) 793-8352
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16249-040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439942400000",
"number": "1124396650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2206 WASHINGTON ST",
"city": "TWO RIVERS",
"state": "WI",
"postal_code": "542412241",
"telephone_number": "920-793-8352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2206 WASHINGTON ST",
"city": "TWO RIVERS",
"state": "WI",
"postal_code": "542412241",
"telephone_number": "920-793-8352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEIST",
"first_name": "DANE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-12",
"last_updated": "2015-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "16249-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Two Rivers, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.