Active NPI
Jaco Fornengo
- Pharmacist
- Riverton, WY
National Provider Identifier
1477023513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4101
- Practice address
- 845 N Federal Blvd
Riverton, WY 82501-2961 - Phone
- (307) 857-6023
- NPI assigned
- Dec 2, 2018
- 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 | 4101 | WY | Primary |
Addresses
Primary practice location
845 N Federal Blvd
Riverton, WY 82501-2961
Mailing address
1311 W Park Ave
Riverton, WY 82501-3260
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 |
|---|---|---|---|
| 4101 | WY | 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 and National Provider Directory roles.
-
- Pharmacy
- Riverton, WY
- NPI 1013096536
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543708800000",
"number": "1477023513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 W PARK AVE",
"city": "RIVERTON",
"state": "WY",
"postal_code": "825013260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "845 N FEDERAL BLVD",
"city": "RIVERTON",
"state": "WY",
"postal_code": "825012961",
"telephone_number": "307-857-6023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORNENGO",
"first_name": "JACO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-12-02",
"last_updated": "2018-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WY",
"license": "4101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverton, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.