NPIMap

Organization Active NPI

Nutritional Designs LLC

  • Community/Retail Pharmacy
  • Racine, WI
National Provider Identifier
1912019837
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
9184-42 Issued in WI
Legal business name
NUTRITIONAL DESIGNS LLC
Doing business as
NUTRITIONAL DESIGNS AND PHARMACY LLC
Practice address
5220 Washington Ave Ste 101
Racine, WI 53406-4228
Phone
(262) 632-6500
Fax
(262) 632-6505
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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

Authorized official

Name
Jody Muniz
Title
Owner
Phone
(262) 632-6500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 9184-42 WI Primary

Addresses

Primary practice location

5220 Washington Ave Ste 101
Racine, WI 53406-4228

Mailing address

5220 Washington Ave
Suite 101
Racine, WI 53406-4228
Phone (262) 632-6500

Other identifiers 2

IdentifierTypeStateIssuer
33281600MedicaidWI
2110287OtherPK

Other names 1

  • NUTRITIONAL DESIGNS AND PHARMACY LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1912019837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 WASHINGTON AVE",
            "address_2": "SUITE 101",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534064228",
            "telephone_number": "262-632-6500",
            "fax_number": "262-632-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 WASHINGTON AVE STE 101",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534064228",
            "telephone_number": "262-632-6500",
            "fax_number": "262-632-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRITIONAL DESIGNS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "MUNIZ",
        "authorized_official_first_name": "JODY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-632-6500"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "9184-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33281600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2110287",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NUTRITIONAL DESIGNS AND PHARMACY LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.

Verify at the official NPI Registry.