Active NPI
Nicholas George Venvertloh, PHARMD
- Pharmacist
- Quincy, IL
National Provider Identifier
1649870213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.297164
- Practice address
- 700 N 54TH St
Quincy, IL 62305-7909 - Phone
- (217) 222-7369
- Fax
- (217) 222-7445
- NPI assigned
- Oct 31, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.297164 | IL | Primary |
Addresses
Primary practice location
700 N 54TH St
Quincy, IL 62305-7909
Mailing address
1032 S 43Rd St
Quincy, IL 62305-5922
Phone (217) 617-1144
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 |
|---|---|---|---|
| 051.297164 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sam's West, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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": "1604102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604102400000",
"number": "1649870213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1032 S 43RD ST",
"city": "QUINCY",
"state": "IL",
"postal_code": "623055922",
"telephone_number": "217-617-1144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 N 54TH ST",
"city": "QUINCY",
"state": "IL",
"postal_code": "623057909",
"telephone_number": "217-222-7369",
"fax_number": "217-222-7445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VENVERTLOH",
"first_name": "NICHOLAS",
"middle_name": "GEORGE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-31",
"last_updated": "2020-10-31",
"certification_date": "2020-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.297164",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quincy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.