Active NPI
Kevin James Trackwell, PHARM.D.
- Pharmacist
- Edwardsville, IL
National Provider Identifier
1265729669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051293998
- Practice address
- 102 W Vandalia St
Edwardsville, IL 62025-1910 - Phone
- (618) 692-7251
- NPI assigned
- Jul 6, 2011
- 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 | 2001030148 | MO | |
| Pharmacist | 183500000X | 051293998 | IL | Primary |
Addresses
Primary practice location
102 W Vandalia St
Edwardsville, IL 62025-1910
Mailing address
102 W Vandalia St
Edwardsville, IL 62025-1910
Phone (618) 692-7251
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 |
|---|---|---|---|
| 051293998 | IL | MD | Pharmacist |
| 2001030148 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312156800000",
"number": "1265729669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 W VANDALIA ST",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620251910",
"telephone_number": "618-692-7251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 W VANDALIA ST",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620251910",
"telephone_number": "618-692-7251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACKWELL",
"first_name": "KEVIN",
"middle_name": "JAMES",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-06",
"last_updated": "2011-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2001030148",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051293998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edwardsville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.