Active NPI
Tyler Joseph Prickette, PHARMD
- Pharmacist
- Fort Atkinson, WI
National Provider Identifier
1225880982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18898-40
- Practice address
- 611 Sherman Ave E
Fort Atkinson, WI 53538-1960 - Phone
- (920) 568-5000
- NPI assigned
- Apr 4, 2024
- Sex
- Male
- 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 | 18898-40 | WI | Primary |
Addresses
Primary practice location
611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Mailing address
207 Radloff St
Fort Atkinson, WI 53538-2814
Phone (920) 427-3644
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
| License | State | Type | Specialty |
|---|---|---|---|
| 18898-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712188800000",
"number": "1225880982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 RADLOFF ST",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535382814",
"telephone_number": "920-427-3644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 SHERMAN AVE E",
"city": "FORT ATKINSON",
"state": "WI",
"postal_code": "535381960",
"telephone_number": "920-568-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRICKETTE",
"first_name": "TYLER",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-04",
"last_updated": "2024-04-04",
"certification_date": "2021-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "18898-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Atkinson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.