James Michael Kavanaugh, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

051-035432 Issued in IL

Practice address

404 N Seymour Ave
Mundelein, IL 60060-1835

Phone

(224) 475-0020

NPI assigned

Apr 2, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

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.

• Interdependent Pharmacy, LLC

  • Community/Retail Pharmacy
  • Mundelein, IL
  • NPI 1316470123
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617321600000",
    "number": "1235718792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "372 YORKSHIRE DR",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600604512",
            "telephone_number": "847-648-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 N SEYMOUR AVE",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601835",
            "telephone_number": "224-475-0020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVANAUGH",
        "first_name": "JAMES",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-02",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051-035432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "051-035432",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jonathan Beckerman DMD, P.C. Dba Excellent Dentistry
• Dashia D Jones
• Jori Riske LCSW, LTD.
• Josie G Oliva DDS PC
• K & R Medical Supplies. Inc
• Amanda Kelley, RN
• Kelly & Zeffery, D.D.S., LTD.
• Chelsie Kelly, OTR/L
• Mikhail Khodarkovskiy, M.D.
• Kwamayne D King

• Pharmacist in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; 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.