NPIMap

Individual provider Active NPI

Jeremy Willette

  • Pharmacist
  • Enterprise, AL
National Provider Identifier
1760765960
Registry record updated Oct 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
14578 Issued in AL
Practice address
112 N Main St
Enterprise, AL 36330-2537
Phone
(334) 347-2506
Fax
(334) 393-8155
NPI assigned
Sep 23, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 14578 AL Primary

Addresses

Primary practice location

112 N Main St
Enterprise, AL 36330-2537

Mailing address

903 Fort Rucker Blvd
Enterprise, AL 36330-2124

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

LicenseStateTypeSpecialty
14578ALMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Bryars-Warren Drug Co, LLC Current Accepting new patients
BBMB LLC Current Accepting new patients
Bryars-Warren Drug Co Past Accepting new patients

Locations

112 N Main St
Enterprise, AL 36330
Phone (334) 347-2506

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509321600000",
    "number": "1760765960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 FORT RUCKER BLVD",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N MAIN ST",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302537",
            "telephone_number": "334-347-2506",
            "fax_number": "334-393-8155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLETTE",
        "first_name": "JEREMY",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-23",
        "last_updated": "2017-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AL",
            "license": "14578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.