Active NPI
Emily Siswanto, PHARMD
- Pharmacist
- Dallas, TX
National Provider Identifier
1255667986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 42767
- Practice address
- 18207 Midway Rd
Dallas, TX 75287-4902 - Phone
- (972) 307-7556
- Fax
- (972) 307-0735
- NPI assigned
- Oct 31, 2009
- Last updated
- Oct 31, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 | 42767 | TX | Primary |
Addresses
Primary practice location
18207 Midway Rd
Dallas, TX 75287-4902
Mailing address
18207 Midway Rd
Dallas, TX 75287-4902
Phone (972) 307-7556
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 |
|---|---|---|---|
| 42767 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256947200000",
"number": "1255667986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18207 MIDWAY RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752874902",
"telephone_number": "972-307-7556",
"fax_number": "972-307-0735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18207 MIDWAY RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752874902",
"telephone_number": "972-307-7556",
"fax_number": "972-307-0735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISWANTO",
"first_name": "EMILY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-31",
"last_updated": "2009-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "42767",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.