Jonathan Lancourt
Individual provider Active NPI Pharmacist · Waterford, WI
NPI 1962810259 · NPPES record last updated Feb 14, 2016
Key facts
- NPI
- 1962810259
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 17557-40 (WI)
- Practice address
- 900 E Main St
Waterford, WI 53185-4536 - Phone
- (262) 514-4290
- NPI assigned
- Jul 30, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17557-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17557-40 | WI | Yes |
Addresses
Primary practice location
900 E Main St
Waterford, WI 53185-4536
Mailing address
900 E Main St
Waterford, WI 53185-4536
Other providers in Waterford, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.