Active NPI
Jerry L Hennen, RPH
- Pharmacist
- West Allis, WI
National Provider Identifier
1821354499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10622-40
- Practice address
- 1540 S 108TH St
West Allis, WI 53214-4019 - Phone
- (414) 453-5806
- Fax
- (414) 453-5052
- NPI assigned
- Apr 7, 2012
- 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 | 10622-40 | WI | Primary |
Addresses
Primary practice location
1540 S 108TH St
West Allis, WI 53214-4019
Mailing address
4200 S Church Dr
New Berlin, WI 53151-5612
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 |
|---|---|---|---|
| 10622-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1333756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477440000000",
"number": "1821354499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 S CHURCH DR",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "531515612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 S 108TH ST",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532144019",
"telephone_number": "414-453-5806",
"fax_number": "414-453-5052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENNEN",
"first_name": "JERRY",
"middle_name": "L",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-07",
"last_updated": "2016-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "10622-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.