Individual provider Active NPI

Patrycja B Mietus, PHARMD

  • Pharmacist
  • Chicago, IL
National Provider Identifier
1538516752
Registry record updated May 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
051.296853 Issued in IL
Practice address
6107 S Archer Ave
Chicago, IL 60638-2743
Phone
(773) 735-0396
Fax
(773) 735-1256
NPI assigned
May 17, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 051.296853 IL Primary

Addresses

Primary practice location

6107 S Archer Ave
Chicago, IL 60638-2743

Mailing address

6107 S Archer Ave
Chicago, IL 60638-2743
Phone (773) 735-0396

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

LicenseStateTypeSpecialty
051.296853ILMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463443200000",
    "number": "1538516752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6107 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382743",
            "telephone_number": "773-735-0396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6107 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382743",
            "telephone_number": "773-735-0396",
            "fax_number": "773-735-1256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIETUS",
        "first_name": "PATRYCJA",
        "middle_name": "B",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-17",
        "last_updated": "2016-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051.296853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.