Active NPI
Alicen Wagenbach, PHARMD
- Pharmacist
- Galesburg, IL
National Provider Identifier
1720361124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051-295368
- Practice address
- 844 W Fremont St
Galesburg, IL 61401-2509 - Phone
- (309) 343-5141
- Fax
- (309) 343-6821
- NPI assigned
- Sep 21, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051-295368 | IL | Primary |
| Pharmacist | 183500000X | 21549 | IA |
Addresses
Primary practice location
844 W Fremont St
Galesburg, IL 61401-2509
Mailing address
6025 170TH St
Burlington, IA 52601-9274
Phone (319) 937-5855
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 |
|---|---|---|---|
| 21549 | IA | MD | Pharmacist |
| 051-295368 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316563200000",
"number": "1720361124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6025 170TH ST",
"city": "BURLINGTON",
"state": "IA",
"postal_code": "526019274",
"telephone_number": "319-937-5855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "844 W FREMONT ST",
"city": "GALESBURG",
"state": "IL",
"postal_code": "614012509",
"telephone_number": "309-343-5141",
"fax_number": "309-343-6821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGENBACH",
"first_name": "ALICEN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-21",
"last_updated": "2011-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051-295368",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "21549",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Galesburg, IL
- Ruby Verma, M.D.
- Alexandra Vernon, ATC
- Ernest Vesta, MD
- Vna Community Services
- Voyage Management Services, Inc. (Caring Senior Service of Galesburg)
- Robert Wagner, M.D.
- Wal-Mart Stores Inc. (Vision Center 30-0775)
- Walgreen Co (Walgreens #04504)
- Walgreen Co (Walgreens #07216)
- Walgreen Co. (Walgreens #7216)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.