Active NPI
Priscilla Anne Stephan
- Pharmacist
- Dyer, IN
National Provider Identifier
1164790069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12968
- Practice address
- 770 Joliet St
Dyer, IN 46311-1720 - Phone
- (219) 322-5305
- Fax
- (219) 322-7131
- NPI assigned
- Dec 6, 2011
- Last updated
- Dec 6, 2011
- Sex
- Female
- 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 | 12968 | IN | Primary |
Addresses
Primary practice location
770 Joliet St
Dyer, IN 46311-1720
Mailing address
770 Joliet St
Dyer, IN 46311-1720
Phone (219) 322-5305
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12968 | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1164790069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "770 JOLIET ST",
"city": "DYER",
"state": "IN",
"postal_code": "463111720",
"telephone_number": "219-322-5305",
"fax_number": "219-322-7131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "770 JOLIET ST",
"city": "DYER",
"state": "IN",
"postal_code": "463111720",
"telephone_number": "219-322-5305",
"fax_number": "219-322-7131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHAN",
"first_name": "PRISCILLA",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-06",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "12968",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dyer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.