Active NPI
Dale A Bultemeier, RPH
- Pharmacist
- Fort Wayne, IN
National Provider Identifier
1457579088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26014654
- Practice address
- 8101 W Jefferson Blvd
Fort Wayne, IN 46804-4163 - Phone
- (260) 969-2418
- Fax
- (260) 432-0493
- NPI assigned
- Apr 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 26014654 | IN | Primary |
Addresses
Primary practice location
8101 W Jefferson Blvd
Fort Wayne, IN 46804-4163
Mailing address
13328 Plumbago CT
Fort Wayne, IN 46814-8843
Phone (260) 969-2418
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 |
|---|---|---|---|
| 26014654 | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457579088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13328 PLUMBAGO CT",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468148843",
"telephone_number": "260-969-2418",
"fax_number": "260-432-0493"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8101 W JEFFERSON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044163",
"telephone_number": "260-969-2418",
"fax_number": "260-432-0493"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULTEMEIER",
"first_name": "DALE",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26014654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.