Michael Carlson, PHARMD
Individual provider Active NPI Pharmacist · Sycamore, IL
NPI 1619684826 · NPPES record last updated Oct 28, 2022
Key facts
- NPI
- 1619684826
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051304332 (IL)
- Practice address
- 541 Puri Pkwy
Sycamore, IL 60178-9029 - Phone
- (815) 991-1232
- NPI assigned
- Oct 28, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051304332 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051304332 | IL | Yes |
Addresses
Primary practice location
541 Puri Pkwy
Sycamore, IL 60178-9029
Mailing address
29W701 Everton Dr Unit 208
Warrenville, IL 60555-3650
Other providers in Sycamore, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.