Active NPI
Mark J Pettinger, RPH
- Pharmacist
- Geneva, IL
National Provider Identifier
1437434933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051040775
- Practice address
- 2100 W State St
Geneva, IL 60134-3693 - Phone
- (630) 262-0970
- Fax
- (630) 262-0974
- NPI assigned
- Oct 15, 2011
- Last updated
- Oct 15, 2011
- 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 | 051040775 | IL | Primary |
Addresses
Primary practice location
2100 W State St
Geneva, IL 60134-3693
Mailing address
1825 JC Kellog St
Sycamore, IL 60178-8782
Phone (815) 991-5716
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 |
|---|---|---|---|
| 051040775 | IL | MD | Pharmacist |
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": "1318636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318636800000",
"number": "1437434933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 JC KELLOG ST",
"city": "SYCAMORE",
"state": "IL",
"postal_code": "601788782",
"telephone_number": "815-991-5716",
"fax_number": "815-991-5716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 W STATE ST",
"city": "GENEVA",
"state": "IL",
"postal_code": "601343693",
"telephone_number": "630-262-0970",
"fax_number": "630-262-0974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTINGER",
"first_name": "MARK",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-15",
"last_updated": "2011-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051040775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Geneva, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.