NPIMap

Individual provider Active NPI

Alexander T Kanack, PHARMD

  • Pharmacist
  • Sidney, NE
National Provider Identifier
1174247654
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
14663 Issued in NE
Practice address
3001 Silverberg Dr
Sidney, NE 69162-3033
Phone
(308) 254-9149
NPI assigned
Sep 28, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 14663 NE Primary

Addresses

Primary practice location

3001 Silverberg Dr
Sidney, NE 69162-3033

Mailing address

3001 Silverberg Dr
Sidney, NE 69162-3033
Phone (308) 254-9149

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
14663NEMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walmart Inc. PastSince Oct 2, 2022 Accepting new patients
Walmart Inc. PastSince Oct 2, 2022 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1174247654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 SILVERBERG DR",
            "city": "SIDNEY",
            "state": "NE",
            "postal_code": "691623033",
            "telephone_number": "308-254-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 SILVERBERG DR",
            "city": "SIDNEY",
            "state": "NE",
            "postal_code": "691623033",
            "telephone_number": "308-254-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANACK",
        "first_name": "ALEXANDER",
        "middle_name": "T",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NE",
            "license": "14663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sidney, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.