Active NPI
Kyle Jansen
- Institutional Pharmacy
- Roanoke, VA
National Provider Identifier
1558117267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Institutional Pharmacy
- License
- 0202221323
- Practice address
- 1906 Belleview Ave SE
Roanoke, VA 24014-1838 - Phone
- (540) 759-1058
- NPI assigned
- Apr 24, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Institutional Pharmacy | 3336I0012X | 0202221323 | VA | Primary |
Addresses
Primary practice location
1906 Belleview Ave SE
Roanoke, VA 24014-1838
Mailing address
1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (607) 342-2433
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 |
|---|---|---|---|
| 0202221323 | VA | MD | Institutional Pharmacy |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713916800000",
"number": "1558117267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1906 BELLEVIEW AVE SE",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240141838",
"telephone_number": "607-342-2433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1906 BELLEVIEW AVE SE",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240141838",
"telephone_number": "540-759-1058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANSEN",
"first_name": "KYLE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-04-24",
"last_updated": "2024-04-24",
"certification_date": "2024-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "3336I0012X",
"taxonomy_group": "",
"desc": "Pharmacy, Institutional Pharmacy",
"state": "VA",
"license": "0202221323",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.