Individual provider Active NPI

Shauna Willeke, PHARMD

  • Pharmacist
  • Newark, OH
National Provider Identifier
1124602602
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
03334688 Issued in OH
Practice address
1320 W Main St
Newark, OH 43055-3699
Phone
(220) 564-3546
NPI assigned
May 10, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 03334688 OH Primary

Addresses

Primary practice location

1320 W Main St
Newark, OH 43055-3699

Mailing address

126 Lincoln Dr
Newark, OH 43055-3434

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

LicenseStateTypeSpecialty
03334688OHMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1124602602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 LINCOLN DR",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430553434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430553699",
            "telephone_number": "220-564-3546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLEKE",
        "first_name": "SHAUNA",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-10",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03334688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.