Active NPI
Jacob Johnson, PHARMD
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Oconomowoc, WI
National Provider Identifier
1629673389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 20413
- Practice address
- 1021 Summit Ave
Oconomowoc, WI 53066-4499 - Phone
- (262) 567-9173
- NPI assigned
- Dec 1, 2020
- Sex
- Male
- Sole proprietor
- No
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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 20413 | WI | Primary |
Addresses
Primary practice location
1021 Summit Ave
Oconomowoc, WI 53066-4499
Mailing address
1021 Summit Ave
Oconomowoc, WI 53066-4499
Phone (262) 567-9173
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 |
|---|---|---|---|
| 20413 | WI | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Wisconsin CVS Pharmacy, L.L.C. | Past | Accepting new patients |
Locations
1021 Summit Ave
Oconomowoc, WI 53066
Phone (262) 567-9173
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648252800000",
"number": "1629673389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 SUMMIT AVE",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530664499",
"telephone_number": "262-567-9173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1021 SUMMIT AVE",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530664499",
"telephone_number": "262-567-9173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JACOB",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-01",
"last_updated": "2022-03-26",
"certification_date": "2022-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "WI",
"license": "20413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.