Van'S Corner Drug

Primary specialty

PharmacistTaxonomy code 183500000X

License

7714-042 Issued in WI

Legal business name

VAN'S CORNER DRUG

Practice address

401 E Main St
Waupun, WI 53963-2161

Phone

(920) 324-5211

Fax

(920) 324-4360

NPI assigned

Oct 26, 2006

Organization subpart

No

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

Authorized official

Name

Mark J Vandelist, RPH

Title

Pharmacist

Phone

(920) 324-5211

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376628396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E MAIN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632161",
            "telephone_number": "920-324-5211",
            "fax_number": "920-324-4360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E MAIN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632161",
            "telephone_number": "920-324-5211",
            "fax_number": "920-324-4360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN'S CORNER DRUG",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VANDELIST",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "920-324-5211",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "7714-042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5114373",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33226400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha L Thiede, APNP
• Donna L Thomas, OTR, CKTP
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• Amy J. Tisdale, LPN
• Torria Van Buren, PSY.D
• Vandecastle Chiropractic, LLC
• Michael John Vandecastle, D.C.
• James Alfred Vanderwerff, R.PH
• VB Anesthesia
• Nicholas James Victor

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.