Active NPI
Jack Kumbalek
- Pharmacist
- Green Bay, WI
National Provider Identifier
1558040493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22192-40
- Practice address
- 500 E Walnut St
Green Bay, WI 54301-5004 - Phone
- (920) 785-5925
- NPI assigned
- Jul 17, 2023
- 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 | 22192-40 | WI | Primary |
Addresses
Primary practice location
500 E Walnut St
Green Bay, WI 54301-5004
Mailing address
816 Marquette Ave
Green Bay, WI 54304-2412
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 |
|---|---|---|---|
| 22192-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
500 E Walnut St
Green Bay, WI 54301
Phone (920) 785-5925
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
- Green Bay, WI
- NPI 1689164725
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689552000000",
"number": "1558040493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "816 MARQUETTE AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543042412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E WALNUT ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543015004",
"telephone_number": "920-785-5925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUMBALEK",
"first_name": "JACK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-17",
"last_updated": "2023-07-17",
"certification_date": "2023-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "22192-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.