Nicholas Stack, B.S. IN PHARMACY

Primary specialty

PharmacistTaxonomy code 183500000X

License

10632-40 Issued in WI

Practice address

5851 S Packard Ave
Cudahy, WI 53110-2615

Phone

(414) 744-6058

NPI assigned

Nov 3, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

Practice roles

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.

• Roundys Supermarkets Inc

  • Community/Retail Pharmacy
  • Marshfield, WI
  • NPI 1013484997
  NPD (past)
• Roundys Supermarkets Inc

  • Community/Retail Pharmacy
  • Cudahy, WI
  • NPI 1174778120
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446508800000",
    "number": "1295108967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1618 S 115TH CT APT 211",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532143785",
            "telephone_number": "414-774-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5851 S PACKARD AVE",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531102615",
            "telephone_number": "414-744-6058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "NICHOLAS",
        "credential": "B.S. IN PHARMACY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-03",
        "last_updated": "2015-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "10632-40",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "10632-40",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Sobieski, PA-C
• Karen Sostarich
• South Shore Dentistry and Implants, LLC
• Tyson Spears Sr., MS, LPC
• Sports Physical Therapists of Cudahy LLC
• Stat Access
• Lynette Stefanec, RN BSN
• Rom A Stevens, M.D.
• Florin Stuleanu, M.D.
• Leyda M Su Ham, D.O.

• Pharmacist in Cudahy, WI
• Providers in Cudahy, WI by specialty
• Pharmacist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.