Mark Alan Wynters, CPHT

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

049274552 Issued in IL

Practice address

2225 W Market St
Bloomington, IL 61705-5014

Phone

(309) 828-8626

NPI assigned

Jan 30, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1611964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1942891171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 GREENBRIAR DR APT 3",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612232",
            "telephone_number": "573-462-0810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 W MARKET ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617055014",
            "telephone_number": "309-828-8626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNTERS",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "CPHT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-30",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "IN",
            "license": "67034956A",
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "IL",
            "license": "049274552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judy Lee Wright, M.D.
• Juliet Rene Wright, MS,LCPC
• Timothy Robert Wright
• Chad Christian Wyatt, D.C.
• Maranda Nicole Wyatt, D.C.
• David Douglas Wyse, D.D.S.
• Courtney Yamada, PT, MS
• Aban Yaqub, DMD
• Craig A. Yates, R.PH
• Kaylee Michele Yates

• Pharmacy Technician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Pharmacy Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.

Verify at the official NPI Registry.