NPIMap

Individual provider Active NPI

Jose M Carrasco, PHARM.D.

  • Pharmacist
  • Grand Chute, WI
National Provider Identifier
1215286752
Registry record updated Sep 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
16879-40 Issued in WI
Practice address
4016 Towne Lakes Cir
Apt #7212
Grand Chute, WI 54913-8006
Phone
(708) 990-9202
NPI assigned
Aug 30, 2012
Sex
Male
Sole proprietor
Yes

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
051296162ILMDPharmacist
16879-40WIMDPharmacist

NPPES NPI Registry

Updated by the provider on Sep 1, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 16879-40 WI Primary
Pharmacist 183500000X 051296162 IL

Addresses

Primary practice location

4016 Towne Lakes Cir
Apt #7212
Grand Chute, WI 54913-8006

Mailing address

4016 Towne Lakes Cir
Apt #7212
Grand Chute, WI 54913-8006
Phone (708) 990-9202

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 1, 2012.

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346457600000",
    "number": "1215286752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4016 TOWNE LAKES CIR",
            "address_2": "APT #7212",
            "city": "GRAND CHUTE",
            "state": "WI",
            "postal_code": "549138006",
            "telephone_number": "708-990-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4016 TOWNE LAKES CIR",
            "address_2": "APT #7212",
            "city": "GRAND CHUTE",
            "state": "WI",
            "postal_code": "549138006",
            "telephone_number": "708-990-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRASCO",
        "first_name": "JOSE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-30",
        "last_updated": "2012-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "16879-40",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051296162",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Chute, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2012; 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.