Active NPI
Dustin Michael Kechisen, PHARMD
- Pharmacist
- State College, PA
National Provider Identifier
1669250312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP457957
- Practice address
- 1101 N Atherton St
State College, PA 16803-2927 - Phone
- (814) 234-4761
- NPI assigned
- Sep 14, 2023
- 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 | RP457957 | PA | Primary |
Addresses
Primary practice location
1101 N Atherton St
State College, PA 16803-2927
Mailing address
423 Centre Rd
Osceola Mills, PA 16666-9104
Phone (814) 577-4086
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 |
|---|---|---|---|
| RP457957 | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pennsylvania CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Pennsylvania CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Thrift Drug Inc | Past | Accepting new patients | |
| Thrift Drug Inc | Past | Accepting new patients |
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.
-
dba Rite Aid Pharmacy 11014
- Community/Retail Pharmacy
- State College, PA
- NPI 1861591125
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695600000000",
"number": "1669250312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "423 CENTRE RD",
"city": "OSCEOLA MILLS",
"state": "PA",
"postal_code": "166669104",
"telephone_number": "814-577-4086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 N ATHERTON ST",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168032927",
"telephone_number": "814-234-4761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KECHISEN",
"first_name": "DUSTIN",
"middle_name": "MICHAEL",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-14",
"last_updated": "2023-09-25",
"certification_date": "2023-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP457957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.