Active NPI
Stephen Tangulie Tonsong, PHARMACIST
- Community/Retail Pharmacy
- Kenosha, WI
National Provider Identifier
1609463546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 20215-40
- Practice address
- 3710 57TH Ave
Kenosha, WI 53144-4820 - Phone
- (262) 652-1474
- NPI assigned
- Dec 27, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20215-40 | WI | |
| Community/Retail Pharmacy | 3336C0003X | 20215-40 | WI | Primary |
Addresses
Primary practice location
3710 57TH Ave
Kenosha, WI 53144-4820
Mailing address
3710 57TH Ave
Kenosha, WI 53144-4820
Phone (262) 652-1474
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20215-40 | Other | WI | PHARMACIST |
| 1965179 | Other | WI | PHARMACIST |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | kenosha | Health Information Exchange (HIE) |
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 |
|---|---|---|---|
| 20215-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609027200000",
"number": "1609463546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3710 57TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531444820",
"telephone_number": "262-652-1474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3710 57TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531444820",
"telephone_number": "262-652-1474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TONSONG",
"first_name": "STEPHEN",
"middle_name": "TANGULIE",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-27",
"last_updated": "2020-12-27",
"certification_date": "2020-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "20215-40",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "WI",
"license": "20215-40",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "20215-40",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "1965179",
"state": "WI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "kenosha",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CVS",
"address_1": "3710 57th Ave",
"city": "Kenosha",
"state": "WI",
"country_code": "US",
"postal_code": "531444820",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.