Noah Paul Burlison
Individual provider Active NPI Pharmacist · Minooka, IL
NPI 1245938232 · NPPES record last updated Feb 20, 2023
Key facts
- NPI
- 1245938232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.305315 (IL)
- Practice address
- 2051 Ridge Rd
Minooka, IL 60447-8863 - Phone
- (815) 467-1254
- NPI assigned
- Feb 20, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.305315 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Drug Stores LLC | Past |
Accepting new patients | |
| American Drug Stores LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.305315 | IL | Yes |
Addresses
Primary practice location
2051 Ridge Rd
Minooka, IL 60447-8863
Mailing address
2303 Candle Wood CT
Plainfield, IL 60586-7246
Phone (630) 303-3261
Other providers in Minooka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.