Active NPI
Alyssa Grycko, PHARMD
- Pharmacist
- Waterloo, IA
National Provider Identifier
1487258737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 23754
- Practice address
- 1501 E San Marnan Dr
Waterloo, IA 50702-4300 - Phone
- (319) 226-6761
- NPI assigned
- Nov 27, 2020
- Sex
- Female
- 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 | 23754 | IA | Primary |
Addresses
Primary practice location
1501 E San Marnan Dr
Waterloo, IA 50702-4300
Mailing address
1501 E San Marnan Dr
Waterloo, IA 50702-4300
Phone (319) 226-6761
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | RxConnect |
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23754 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606435200000",
"number": "1487258737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 E SAN MARNAN DR",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507024300",
"telephone_number": "319-226-6761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 E SAN MARNAN DR",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507024300",
"telephone_number": "319-226-6761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRYCKO",
"first_name": "ALYSSA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-27",
"last_updated": "2020-11-27",
"certification_date": "2020-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "23754",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "RxConnect",
"affiliation": "N",
"address_1": "1501 E San Marnan Dr",
"city": "Waterloo",
"state": "IA",
"country_code": "US",
"postal_code": "507024300",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.