Active NPI
Diane Michelle Blue, RPH
- Pharmacist
- O Fallon, IL
National Provider Identifier
1194201160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051287796
- Practice address
- 907 E Highway 50
O Fallon, IL 62269-2856 - Phone
- (618) 632-9873
- Fax
- (618) 632-0729
- NPI assigned
- Jul 12, 2018
- 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 | 051287796 | IL | Primary |
Addresses
Primary practice location
907 E Highway 50
O Fallon, IL 62269-2856
Mailing address
1225 Shadow Ridge Xing
O Fallon, IL 62269-3119
Phone (618) 660-6816
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 |
|---|---|---|---|
| 051287796 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531353600000",
"number": "1194201160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 SHADOW RIDGE XING",
"city": "O FALLON",
"state": "IL",
"postal_code": "622693119",
"telephone_number": "618-660-6816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "907 E HIGHWAY 50",
"city": "O FALLON",
"state": "IL",
"postal_code": "622692856",
"telephone_number": "618-632-9873",
"fax_number": "618-632-0729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUE",
"first_name": "DIANE",
"middle_name": "MICHELLE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-12",
"last_updated": "2018-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051287796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.