Douglas Scott Cockrell, PHARMD, RPH
Individual provider Active NPI Pharmacist · Chester, IL
NPI 1669986949 · NPPES record last updated Nov 26, 2017
Key facts
- NPI
- 1669986949
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051288811 (IL)
- Practice address
- 2206 State St
Chester, IL 62233-1142 - Phone
- (618) 826-4898
- Fax
- (618) 826-3751
- NPI assigned
- Nov 26, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051288811 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051288811 | IL | Yes |
Addresses
Primary practice location
2206 State St
Chester, IL 62233-1142
Mailing address
3774 State Route 4
Marissa, IL 62257-2902
Phone (618) 979-3182
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051288811 | Other | IL | STATE LICENSE |
Other providers in Chester, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.