Active NPI
Peter Park, RPH
- Pharmacist
- Champaign, IL
National Provider Identifier
1437762275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.302714
- Practice address
- 1713 W Springfield Ave
Champaign, IL 61821-3011 - Phone
- (217) 356-2529
- NPI assigned
- Aug 30, 2020
- Last updated
- Aug 30, 2020
- 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 | 051.302714 | IL | Primary |
Addresses
Primary practice location
1713 W Springfield Ave
Champaign, IL 61821-3011
Mailing address
3402 Mission Dr
Champaign, IL 61822-9819
Phone (847) 414-9769
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 |
|---|---|---|---|
| 051.302714 | 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": "1598745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598745600000",
"number": "1437762275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3402 MISSION DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618229819",
"telephone_number": "847-414-9769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1713 W SPRINGFIELD AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618213011",
"telephone_number": "217-356-2529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-30",
"last_updated": "2020-08-30",
"certification_date": "2020-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.302714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.