Active NPI
Spencer Polacek, PHARMD
- Pharmacist
- Waterford, WI
National Provider Identifier
1285267872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19178-40
- Practice address
- 900 E Main St
Waterford, WI 53185-4536 - Phone
- (262) 514-4290
- NPI assigned
- Feb 21, 2020
- Last updated
- Feb 21, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19178-40 | WI | Primary |
Addresses
Primary practice location
900 E Main St
Waterford, WI 53185-4536
Mailing address
900 E Main St
Waterford, WI 53185-4536
Phone (262) 514-4290
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 |
|---|---|---|---|
| 19178-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
900 E Main St
Waterford, WI 53185
Phone (262) 514-4290
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": "1582243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582243200000",
"number": "1285267872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 E MAIN ST",
"city": "WATERFORD",
"state": "WI",
"postal_code": "531854536",
"telephone_number": "262-514-4290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 E MAIN ST",
"city": "WATERFORD",
"state": "WI",
"postal_code": "531854536",
"telephone_number": "262-514-4290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLACEK",
"first_name": "SPENCER",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-21",
"last_updated": "2020-02-21",
"certification_date": "2020-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "19178-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterford, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.