Active NPI
Nicholas Super, PHARM.D.
- Ambulatory Care Pharmacist
- Hines, IL
National Provider Identifier
1508096686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Care Pharmacist
- License
- 051.293513
- Practice address
- 5000 S 5TH Ave
Hines, IL 60141-3030 - Phone
- (708) 940-1808
- NPI assigned
- Jul 22, 2009
- 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 |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | 051.293513 | IL | Primary |
Addresses
Primary practice location
5000 S 5TH Ave
Hines, IL 60141-3030
Mailing address
831 Clarence Ave
Oak Park, IL 60304-1307
Phone (773) 899-5234
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 |
|---|---|---|---|
| 051.293513 | IL | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700611200000",
"number": "1508096686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "831 CLARENCE AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603041307",
"telephone_number": "773-899-5234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 S 5TH AVE",
"city": "HINES",
"state": "IL",
"postal_code": "601413030",
"telephone_number": "708-940-1808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPER",
"first_name": "NICHOLAS",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-22",
"last_updated": "2023-11-22",
"certification_date": "2023-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "IL",
"license": "051.293513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hines, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.