Active NPI
Mark Alan Rysticken, RPH
- Pharmacist
- Brillion, WI
National Provider Identifier
1164618013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11946
- Practice address
- 1010 W Ryan St
Brillion, WI 54110-1079 - Phone
- (920) 756-2640
- Fax
- (920) 756-9262
- NPI assigned
- Sep 24, 2007
- 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 | 11946 | WI | Primary |
Addresses
Primary practice location
1010 W Ryan St
Brillion, WI 54110-1079
Mailing address
1010 W Ryan St
Brillion, WI 54110-1079
Phone (920) 756-2640
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352246400000",
"number": "1164618013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 W RYAN ST",
"city": "BRILLION",
"state": "WI",
"postal_code": "541101079",
"telephone_number": "920-756-2640",
"fax_number": "920-756-9262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 W RYAN ST",
"city": "BRILLION",
"state": "WI",
"postal_code": "541101079",
"telephone_number": "920-756-2640",
"fax_number": "920-756-9262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYSTICKEN",
"first_name": "MARK",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-24",
"last_updated": "2012-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "11946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brillion, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.