Active NPI
Kourtney Fermanich, PHARM D
- Compounded Sterile Preparations Pharmacist
- Hines, IL
National Provider Identifier
1679088124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Compounded Sterile Preparations Pharmacist
- License
- 05130055
- Practice address
- 5000 S 5TH Ave
Hines, IL 60141-3030 - Phone
- (815) 227-0081
- NPI assigned
- Dec 6, 2017
- 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 |
|---|---|---|---|---|
| Compounded Sterile Preparations Pharmacist | 1835C0207X | 05130055 | IL | Primary |
Addresses
Primary practice location
5000 S 5TH Ave
Hines, IL 60141-3030
Mailing address
4704 Rainbow RDG
Rockford, IL 61109-3536
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 |
|---|---|---|---|
| 05130055 | IL | MD | Medical license number |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697500800000",
"number": "1679088124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4704 RAINBOW RDG",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611093536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 S 5TH AVE",
"city": "HINES",
"state": "IL",
"postal_code": "601413030",
"telephone_number": "815-227-0081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERMANICH",
"first_name": "KOURTNEY",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-06",
"last_updated": "2023-10-17",
"certification_date": "2023-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "1835C0207X",
"taxonomy_group": "",
"desc": "Pharmacist, Compounded Sterile Preparations",
"state": "IL",
"license": "05130055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hines, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.