Active NPI
Charles Nolis Anderson, PHARM. D
- Pharmacist
- Homewood, IL
National Provider Identifier
1376896084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051296289
- Practice address
- 17605 S. Halsted Street
Homewood, IL 60430 - Phone
- (708) 335-5250
- NPI assigned
- Oct 18, 2012
- 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 | 051296289 | IL | Primary |
Addresses
Primary practice location
17605 S. Halsted Street
Homewood, IL 60430
Mailing address
457 E 41St St
Chicago, IL 60653-2705
Phone (773) 808-4310
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051296289 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350518400000",
"number": "1376896084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "457 E 41ST ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606532705",
"telephone_number": "773-808-4310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17605 S. HALSTED STREET",
"city": "HOMEWOOD",
"state": "IL",
"postal_code": "60430",
"telephone_number": "708-335-5250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "CHARLES",
"middle_name": "NOLIS",
"name_prefix": "Mr.",
"credential": "PHARM. D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-18",
"last_updated": "2012-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051296289",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.