Active NPI
Theodore Victor Fusco III, RPH
- Pharmacist
- Waukegan, IL
National Provider Identifier
1689884249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051287055
- Practice address
- 920 N Green Bay Rd
Waukegan, IL 60085-2240 - Phone
- (847) 623-7066
- NPI assigned
- May 23, 2007
- 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 | 051287055 | IL | Primary |
Addresses
Primary practice location
920 N Green Bay Rd
Waukegan, IL 60085-2240
Mailing address
529 N Howard Ave
Elmhurst, IL 60126-2024
Phone (630) 279-0317
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 |
|---|---|---|---|
| 051287055 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Drug Stores LLC | Past | Accepting new patients | |
| American Drug Stores LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Community/Retail Pharmacy
- Diamond, IL
- NPI 1013786706
-
- Community/Retail Pharmacy
- Waukegan, IL
- NPI 1477591782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420848000000",
"number": "1689884249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "529 N HOWARD AVE",
"city": "ELMHURST",
"state": "IL",
"postal_code": "601262024",
"telephone_number": "630-279-0317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 N GREEN BAY RD",
"city": "WAUKEGAN",
"state": "IL",
"postal_code": "600852240",
"telephone_number": "847-623-7066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUSCO",
"first_name": "THEODORE",
"middle_name": "VICTOR",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2015-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051287055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waukegan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.