Active NPI
Ted Cooper
- Pharmacist
- Dixon, IL
National Provider Identifier
1851985618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 05103161
- Practice address
- 301 N Galena Ave
Dixon, IL 61021-2113 - Phone
- (815) 284-8000
- NPI assigned
- Feb 23, 2021
- Last updated
- Feb 23, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | 05103161 | IL | Primary |
Addresses
Primary practice location
301 N Galena Ave
Dixon, IL 61021-2113
Mailing address
301 N Galena Ave
Dixon, IL 61021-2113
Phone (815) 284-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05103161 | Other | IL | PHARMACIST LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 05103161 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614038400000",
"number": "1851985618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 N GALENA AVE",
"city": "DIXON",
"state": "IL",
"postal_code": "610212113",
"telephone_number": "815-284-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N GALENA AVE",
"city": "DIXON",
"state": "IL",
"postal_code": "610212113",
"telephone_number": "815-284-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOPER",
"first_name": "TED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-23",
"last_updated": "2021-02-23",
"certification_date": "2021-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "05103161",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "05103161",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dixon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.