Active NPI
Randall Liljegren, R.PH.
- Pharmacist
- Waupaca, WI
National Provider Identifier
1326433459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11656-040
- Practice address
- 825 W Fulton St
Waupaca, WI 54981-1471 - Phone
- (715) 258-9000
- Fax
- (715) 258-4119
- NPI assigned
- Apr 6, 2015
- Sex
- Male
- 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 | 11656-040 | WI | Primary |
Addresses
Primary practice location
825 W Fulton St
Waupaca, WI 54981-1471
Mailing address
825 W Fulton St
Waupaca, WI 54981-1471
Phone (715) 258-9000
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11656-040 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428278400000",
"number": "1326433459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 W FULTON ST",
"city": "WAUPACA",
"state": "WI",
"postal_code": "549811471",
"telephone_number": "715-258-9000",
"fax_number": "715-258-4119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 W FULTON ST",
"city": "WAUPACA",
"state": "WI",
"postal_code": "549811471",
"telephone_number": "715-258-9000",
"fax_number": "715-258-4119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILJEGREN",
"first_name": "RANDALL",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-06",
"last_updated": "2015-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "11656-040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waupaca, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.