Active NPI
Beth Keith-Mudgette, RPH
- Pharmacist
- Du Quoin, IL
National Provider Identifier
1669072740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.287795
- Practice address
- 215 E Grantway St
Du Quoin, IL 62832-1923 - Phone
- (618) 542-2488
- NPI assigned
- Oct 28, 2020
- Last updated
- Oct 28, 2020
- Sex
- Female
- 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 | 051.287795 | IL | Primary |
Addresses
Primary practice location
215 E Grantway St
Du Quoin, IL 62832-1923
Mailing address
215 E Grantway St
Du Quoin, IL 62832-1923
Phone (618) 542-2488
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.287795 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1669072740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 E GRANTWAY ST",
"city": "DU QUOIN",
"state": "IL",
"postal_code": "628321923",
"telephone_number": "618-542-2488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 E GRANTWAY ST",
"city": "DU QUOIN",
"state": "IL",
"postal_code": "628321923",
"telephone_number": "618-542-2488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEITH-MUDGETTE",
"first_name": "BETH",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-28",
"last_updated": "2020-10-28",
"certification_date": "2020-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.287795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Du Quoin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.