Active NPI
Sara Wise
- Pharmacist
- Belleville, IL
National Provider Identifier
1346524022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.289202
- Practice address
- 1108 Hartman LN
Belleville, IL 62221-7921 - Phone
- (618) 239-6617
- Fax
- (618) 239-6625
- NPI assigned
- Sep 29, 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 | 051.289202 | IL | Primary |
Addresses
Primary practice location
1108 Hartman LN
Belleville, IL 62221-7921
Mailing address
421 Amy Dr
O Fallon, IL 62269-3408
Phone (618) 624-6038
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 |
|---|---|---|---|
| 051.289202 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1346524022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 AMY DR",
"city": "O FALLON",
"state": "IL",
"postal_code": "622693408",
"telephone_number": "618-624-6038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1108 HARTMAN LN",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622217921",
"telephone_number": "618-239-6617",
"fax_number": "618-239-6625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "SARA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-29",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.289202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.