Active NPI
Keri Lynn Willoughby, PHARM.D.
- Pharmacist
- Rockford, IL
National Provider Identifier
1619231503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.292879
- Practice address
- 209 9TH St
Suite 200
Rockford, IL 61104-2235 - Phone
- (815) 490-5871
- NPI assigned
- Jun 26, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.292879 | IL | Primary |
| Pharmacist | 183500000X | 18251 | NV |
Addresses
Primary practice location
209 9TH St
Suite 200
Rockford, IL 61104-2235
Mailing address
11653 Waidi Ave
Machesney Park, IL 61115-1032
Phone (815) 404-3300
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
| License | State | Type | Specialty |
|---|---|---|---|
| 051.292879 | IL | MD | Pharmacist |
| 18251 | NV | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340668800000",
"number": "1619231503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11653 WAIDI AVE",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611151032",
"telephone_number": "815-404-3300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 9TH ST",
"address_2": "SUITE 200",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611042235",
"telephone_number": "815-490-5871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLOUGHBY",
"first_name": "KERI",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-26",
"last_updated": "2012-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.292879",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "18251",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.