Active NPI
Kenechukwu Stanley Ezike
- Pharmacist
- La Grange Highlands, IL
National Provider Identifier
1649871344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.303090
- Practice address
- 6600 Willow Springs Rd
La Grange Highlands, IL 60525-4593 - Phone
- (708) 588-1253
- NPI assigned
- Nov 8, 2020
- Last updated
- Nov 8, 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 | 183500000X | 051.303090 | IL | Primary |
Addresses
Primary practice location
6600 Willow Springs Rd
La Grange Highlands, IL 60525-4593
Mailing address
814 Hillberry CT
La Grange, IL 60525-2647
Phone (708) 539-7479
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Url |
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 |
|---|---|---|---|
| 051.303090 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604793600000",
"number": "1649871344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 HILLBERRY CT",
"city": "LA GRANGE",
"state": "IL",
"postal_code": "605252647",
"telephone_number": "708-539-7479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6600 WILLOW SPRINGS RD",
"city": "LA GRANGE HIGHLANDS",
"state": "IL",
"postal_code": "605254593",
"telephone_number": "708-588-1253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZIKE",
"first_name": "KENECHUKWU",
"middle_name": "STANLEY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-08",
"last_updated": "2020-11-08",
"certification_date": "2020-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.303090",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Url",
"affiliation": "N",
"address_1": "6600 Willow Springs Rd",
"city": "LA Grange Highlands",
"state": "IL",
"country_code": "US",
"postal_code": "605254593",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in La Grange Highlands, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.