Active NPI
Benjamin Matthew Lilleberg
- Pharmacist
- New Richmond, WI
National Provider Identifier
1205549425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 21489-40
- Practice address
- 250 Richmond Way
New Richmond, WI 54017-6829 - Phone
- (715) 246-9097
- NPI assigned
- Jan 3, 2023
- 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 | 21489-40 | WI | Primary |
Addresses
Primary practice location
250 Richmond Way
New Richmond, WI 54017-6829
Mailing address
659 Short St
Saint Paul, MN 55106-6221
Phone (763) 447-7276
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 |
|---|---|---|---|
| 21489-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672704000000",
"number": "1205549425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "659 SHORT ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551066221",
"telephone_number": "763-447-7276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 RICHMOND WAY",
"city": "NEW RICHMOND",
"state": "WI",
"postal_code": "540176829",
"telephone_number": "715-246-9097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLEBERG",
"first_name": "BENJAMIN",
"middle_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-03",
"last_updated": "2023-01-03",
"certification_date": "2023-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "21489-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Richmond, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.