Active NPI
Jaime Debartolo, PHARMD
- Pharmacist
- Manitowoc, WI
National Provider Identifier
1487422507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22403-40
- Practice address
- 1818 S Rapids Rd
Manitowoc, WI 54220-9375 - Phone
- (920) 663-3836
- NPI assigned
- Dec 18, 2023
- 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 | 22403-40 | WI | Primary |
Addresses
Primary practice location
1818 S Rapids Rd
Manitowoc, WI 54220-9375
Mailing address
8217 60TH Ave
Kenosha, WI 53142-1836
Phone (262) 909-4024
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 |
|---|---|---|---|
| 22403-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702857600000",
"number": "1487422507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8217 60TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531421836",
"telephone_number": "262-909-4024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1818 S RAPIDS RD",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542209375",
"telephone_number": "920-663-3836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBARTOLO",
"first_name": "JAIME",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-18",
"last_updated": "2023-12-18",
"certification_date": "2023-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "22403-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.