Active NPI
Dmitri Mayer, RPH
- Geriatric Pharmacist
- Green Bay, WI
National Provider Identifier
1255421608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- 13720-40
- Practice address
- 2851 University Ave
Green Bay, WI 54311-5855 - Phone
- (920) 431-2584
- Fax
- (414) 389-4216
- NPI assigned
- Oct 14, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13720 | WI | |
| Geriatric Pharmacist | 1835G0303X | 13720-40 | WI | Primary |
Addresses
Primary practice location
2851 University Ave
Green Bay, WI 54311-5855
Mailing address
5000 W National Ave
Milwaukee, WI 53295-0001
Phone (920) 431-2584
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13720-40 | WI | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779321600000",
"number": "1255421608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 W NATIONAL AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532950001",
"telephone_number": "920-431-2584",
"fax_number": "414-389-4216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2851 UNIVERSITY AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115855",
"telephone_number": "920-431-2584",
"fax_number": "414-389-4216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYER",
"first_name": "DMITRI",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-14",
"last_updated": "2026-05-21",
"certification_date": "2026-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "13720",
"primary": false
},
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "WI",
"license": "13720-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.