Active NPI
Marc Christopher Ertz, R.PH.
- Pharmacist
- La Crosse, WI
National Provider Identifier
1346686300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12180-40
- Practice address
- 4344 Mormon Coulee Rd
La Crosse, WI 54601-7908 - Phone
- (608) 788-8860
- Fax
- (608) 788-5790
- NPI assigned
- May 17, 2013
- 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 | 12180-40 | WI | Primary |
Addresses
Primary practice location
4344 Mormon Coulee Rd
La Crosse, WI 54601-7908
Mailing address
4344 Mormon Coulee Rd
La Crosse, WI 54601-7908
Phone (608) 788-8860
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 |
|---|---|---|---|
| 12180-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368748800000",
"number": "1346686300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4344 MORMON COULEE RD",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546017908",
"telephone_number": "608-788-8860",
"fax_number": "608-788-5790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4344 MORMON COULEE RD",
"city": "LA CROSSE",
"state": "WI",
"postal_code": "546017908",
"telephone_number": "608-788-8860",
"fax_number": "608-788-5790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERTZ",
"first_name": "MARC",
"middle_name": "CHRISTOPHER",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-17",
"last_updated": "2013-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "12180-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Crosse, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.