Individual provider Active NPI

Joseph Raymond Fiesel, PHARM.D.

  • Pharmacist
  • Rockford, IL
National Provider Identifier
1780970988
Registry record updated Jun 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
051292031 Issued in IL
Practice address
6560 E State St
T-0810
Rockford, IL 61108-2545
Phone
(815) 227-9777
Fax
(815) 227-9777
NPI assigned
Jun 26, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 26, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 051292031 IL Primary

Addresses

Primary practice location

6560 E State St
T-0810
Rockford, IL 61108-2545

Mailing address

6560 E State St
Rockford, IL 61108-2545
Phone (815) 227-9777

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

LicenseStateTypeSpecialty
051292031ILMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1309046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309046400000",
    "number": "1780970988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6560 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082545",
            "telephone_number": "815-227-9777",
            "fax_number": "815-227-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6560 E STATE ST",
            "address_2": "T-0810",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082545",
            "telephone_number": "815-227-9777",
            "fax_number": "815-227-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIESEL",
        "first_name": "JOSEPH",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-26",
        "last_updated": "2011-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051292031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.

Verify at the official NPI Registry.