Active NPI
John Ross Mittermann, RPH
- Pharmacist
- Quincy, IL
National Provider Identifier
1801921267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051-028824
- Practice address
- 1400 Harrison St
Quincy, IL 62301-6706 - Phone
- (217) 222-2930
- NPI assigned
- Feb 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 | 051-028824 | IL | Primary |
Addresses
Primary practice location
1400 Harrison St
Quincy, IL 62301-6706
Mailing address
211 Morgan St
Keokuk, IA 52632-5942
Phone (319) 572-8003
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 |
|---|---|---|---|
| 051-028824 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602806400000",
"number": "1801921267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 MORGAN ST",
"city": "KEOKUK",
"state": "IA",
"postal_code": "526325942",
"telephone_number": "319-572-8003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 HARRISON ST",
"city": "QUINCY",
"state": "IL",
"postal_code": "623016706",
"telephone_number": "217-222-2930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITTERMANN",
"first_name": "JOHN",
"middle_name": "ROSS",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-23",
"last_updated": "2020-10-16",
"certification_date": "2020-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051-028824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quincy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.