Active NPI
Mark Rudolph Selle, RPH
- Pharmacist
- West Bend, WI
National Provider Identifier
1144494238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9353-040
- Practice address
- 5595 County Road Z
Cedar Lake Campus Pharmacy
West Bend, WI 53095-9224 - Phone
- (262) 306-2140
- NPI assigned
- Apr 18, 2008
- 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 | 9353-040 | WI | Primary |
Addresses
Primary practice location
5595 County Road Z
Cedar Lake Campus Pharmacy
West Bend, WI 53095-9224
Mailing address
5595 County Road Z
Cedar Lake Campus Pharmacy
West Bend, WI 53095-9224
Phone (262) 306-2140
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 |
|---|---|---|---|
| 9353-040 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350518400000",
"number": "1144494238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5595 COUNTY ROAD Z",
"address_2": "CEDAR LAKE CAMPUS PHARMACY",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530959224",
"telephone_number": "262-306-2140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5595 COUNTY ROAD Z",
"address_2": "CEDAR LAKE CAMPUS PHARMACY",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530959224",
"telephone_number": "262-306-2140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELLE",
"first_name": "MARK",
"middle_name": "RUDOLPH",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-18",
"last_updated": "2012-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "9353-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.