Active NPI
Nicole L McBride, PHARMD
- Pharmacist
- O Fallon, IL
National Provider Identifier
1285916965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051-291904
- Practice address
- 704 Cambridge Blvd
O Fallon, IL 62269-1964 - Phone
- (618) 632-6920
- Fax
- (618) 632-7228
- NPI assigned
- Sep 19, 2011
- Sex
- Female
- 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 | 051-291904 | IL | Primary |
Addresses
Primary practice location
704 Cambridge Blvd
O Fallon, IL 62269-1964
Mailing address
13822 N Prairie Rd
Hoyleton, IL 62803-2312
Phone (618) 978-6393
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 |
|---|---|---|---|
| 051-291904 | IL | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316390400000",
"number": "1285916965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13822 N PRAIRIE RD",
"city": "HOYLETON",
"state": "IL",
"postal_code": "628032312",
"telephone_number": "618-978-6393",
"fax_number": "618-632-7228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 CAMBRIDGE BLVD",
"city": "O FALLON",
"state": "IL",
"postal_code": "622691964",
"telephone_number": "618-632-6920",
"fax_number": "618-632-7228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCBRIDE",
"first_name": "NICOLE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-19",
"last_updated": "2011-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051-291904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.