Active NPI
Douglas Scott Petry, RPH
- Pharmacist
- Indianapolis, IN
National Provider Identifier
1689397150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26015899A
- Practice address
- 1030 N Arlington Ave
Indianapolis, IN 46219-3261 - Phone
- (317) 353-8106
- NPI assigned
- Sep 20, 2022
- Last updated
- Sep 20, 2022
- 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 | 26015899A | IN | Primary |
Addresses
Primary practice location
1030 N Arlington Ave
Indianapolis, IN 46219-3261
Mailing address
1030 N Arlington Ave
Indianapolis, IN 46219-3261
Phone (317) 353-8106
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 |
|---|---|---|---|
| 26015899A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hook-Superx LLC | Past | Accepting new patients |
Organizations & group practices 1
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": "1663632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663632000000",
"number": "1689397150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1030 N ARLINGTON AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462193261",
"telephone_number": "317-353-8106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 N ARLINGTON AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462193261",
"telephone_number": "317-353-8106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRY",
"first_name": "DOUGLAS",
"middle_name": "SCOTT",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-20",
"last_updated": "2022-09-20",
"certification_date": "2022-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26015899A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.