Active NPI
Theresa Lynn Pucylowski, RPH
- Pharmacist
- West Allis, WI
National Provider Identifier
1184901340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10645
- Practice address
- 2677 S 108TH St
West Allis, WI 53227-1925 - Phone
- (414) 545-1440
- Fax
- (414) 545-0896
- NPI assigned
- Nov 15, 2011
- Sex
- Female
- Sole proprietor
- No
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 | 10645 | WI | Primary |
Addresses
Primary practice location
2677 S 108TH St
West Allis, WI 53227-1925
Mailing address
2677 S 108TH St
West Allis, WI 53227-1925
Phone (414) 545-1440
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
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321315200000",
"number": "1184901340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2677 S 108TH ST",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532271925",
"telephone_number": "414-545-1440",
"fax_number": "414-545-0896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2677 S 108TH ST",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532271925",
"telephone_number": "414-545-1440",
"fax_number": "414-545-0896"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCYLOWSKI",
"first_name": "THERESA",
"middle_name": "LYNN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-15",
"last_updated": "2011-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "10645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.