Individual provider Active NPI

Marylou Cecelia Mettler, RPH

  • Pharmacist
  • Fort Wayne, IN
National Provider Identifier
1831688100
Registry record updated May 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
2601569A Issued in IN
Practice address
1900 Carew St Ste 4
Fort Wayne, IN 46805-4765
Phone
(260) 373-9775
Fax
(260) 373-9789
NPI assigned
May 2, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 26015690A KS
Pharmacist 183500000X 2601569A IN Primary

Addresses

Primary practice location

1900 Carew St Ste 4
Fort Wayne, IN 46805-4765

Mailing address

1900 Carew St Ste 4
Fort Wayne, IN 46805-4765
Phone (260) 373-9775

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

LicenseStateTypeSpecialty
2601569AINMDPharmacist
26015690AKSMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Hospital Inc. Past Accepting new patients

Organizations & group practices 1

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": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525219200000",
    "number": "1831688100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CAREW ST STE 4",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054765",
            "telephone_number": "260-373-9775",
            "fax_number": "260-373-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CAREW ST STE 4",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054765",
            "telephone_number": "260-373-9775",
            "fax_number": "260-373-9789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "METTLER",
        "first_name": "MARYLOU",
        "middle_name": "CECELIA",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-02",
        "last_updated": "2018-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KS",
            "license": "26015690A",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "2601569A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; 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.