Active NPI
Fairy Patel
- Pharmacist
- Peoria, IL
National Provider Identifier
1700403623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051300537
- Practice address
- 2324 W War Memorial Dr
Peoria, IL 61614-5552 - Phone
- (309) 685-5209
- NPI assigned
- Jun 26, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051300537 | IL | Primary |
Addresses
Primary practice location
2324 W War Memorial Dr
Peoria, IL 61614-5552
Mailing address
2324 W War Memorial Drive
Peoria, IL 61614-5552
Phone (309) 685-5209
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051300537 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593129600000",
"number": "1700403623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2324 W WAR MEMORIAL DRIVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145552",
"telephone_number": "309-685-5209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2324 W WAR MEMORIAL DR",
"city": "PEORIA",
"state": "IL",
"postal_code": "616145552",
"telephone_number": "309-685-5209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEL",
"first_name": "FAIRY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-26",
"last_updated": "2020-06-26",
"certification_date": "2020-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051300537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.