Active NPI
Joanna Kaczmarczyk
- Pharmacist
- Burbank, IL
National Provider Identifier
1417478488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.301144
- Practice address
- 5555 W 79TH St
Burbank, IL 60459-1301 - Phone
- (708) 499-3755
- NPI assigned
- Jun 29, 2017
- Last updated
- Feb 12, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 049190847 | IL | |
| Pharmacist | 183500000X | 051.301144 | IL | Primary |
Addresses
Primary practice location
5555 W 79TH St
Burbank, IL 60459-1301
Mailing address
5555 W 79TH St
Burbank, IL 60459-1301
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 |
|---|---|---|---|
| 051.301144 | IL | MD | Pharmacist |
| 049190847 | IL | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613088000000",
"number": "1417478488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5555 W 79TH ST",
"city": "BURBANK",
"state": "IL",
"postal_code": "604591301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5555 W 79TH ST",
"city": "BURBANK",
"state": "IL",
"postal_code": "604591301",
"telephone_number": "708-499-3755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KACZMARCZYK",
"first_name": "JOANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-29",
"last_updated": "2021-02-12",
"certification_date": "2021-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "IL",
"license": "049190847",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.301144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.