Active NPI
Susan Lynn Way
- Pharmacist
- Wood River, IL
National Provider Identifier
1275134652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051287184
- Practice address
- 610 Wesley Dr
Wood River, IL 62095-1894 - Phone
- (618) 259-0293
- Fax
- (618) 259-8757
- NPI assigned
- Nov 3, 2020
- 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 | 051287184 | IL | Primary |
Addresses
Primary practice location
610 Wesley Dr
Wood River, IL 62095-1894
Mailing address
2 Sunny Dale CT
Glen Carbon, IL 62034-4063
Phone (618) 741-7744
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051287184 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604361600000",
"number": "1275134652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 SUNNY DALE CT",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620344063",
"telephone_number": "618-741-7744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 WESLEY DR",
"city": "WOOD RIVER",
"state": "IL",
"postal_code": "620951894",
"telephone_number": "618-259-0293",
"fax_number": "618-259-8757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAY",
"first_name": "SUSAN",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-03",
"last_updated": "2020-11-03",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051287184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wood River, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.