Active NPI
Carrie Lynn Tilkens, RPH
- Pharmacist
- Green Bay, WI
National Provider Identifier
1558998864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12363
- Practice address
- 2400 Velp Ave
Green Bay, WI 54303-6534 - Phone
- (920) 434-3954
- Fax
- (920) 434-9006
- NPI assigned
- Mar 25, 2020
- Last updated
- Mar 25, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12363 | WI | Primary |
Addresses
Primary practice location
2400 Velp Ave
Green Bay, WI 54303-6534
Mailing address
2400 Velp Ave
Green Bay, WI 54303-6534
Phone (920) 434-3954
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12363 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients | |
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585094400000",
"number": "1558998864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 VELP AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543036534",
"telephone_number": "920-434-3954",
"fax_number": "920-434-9006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 VELP AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543036534",
"telephone_number": "920-434-3954",
"fax_number": "920-434-9006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILKENS",
"first_name": "CARRIE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-25",
"last_updated": "2020-03-25",
"certification_date": "2020-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "12363",
"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 Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.