Active NPI
Patcharaporn Keane, PHARMD
- Pharmacist
- Peru, IL
National Provider Identifier
1972199115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.296468
- Practice address
- 1004 Shooting Park Rd
Peru, IL 61354-1871 - Phone
- (815) 224-1411
- NPI assigned
- Dec 11, 2020
- Last updated
- Dec 11, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 051.296468 | IL | Primary |
Addresses
Primary practice location
1004 Shooting Park Rd
Peru, IL 61354-1871
Mailing address
4902 N Magnolia Ave Apt 3
Chicago, IL 60640-7546
Phone (630) 888-2551
Other practice location 1
701 Winthrop Ave
Glendale Heights, IL 60139-1405
Phone (630) 545-7331
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.296468 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607644800000",
"number": "1972199115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4902 N MAGNOLIA AVE APT 3",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606407546",
"telephone_number": "630-888-2551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 SHOOTING PARK RD",
"city": "PERU",
"state": "IL",
"postal_code": "613541871",
"telephone_number": "815-224-1411"
}
],
"practiceLocations": [
{
"address_1": "701 Winthrop Ave",
"address_purpose": "LOCATION",
"city": "Glendale Heights",
"state": "IL",
"postal_code": "601391405",
"country_code": "US",
"telephone_number": "630-545-7331",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KEANE",
"first_name": "PATCHARAPORN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-11",
"last_updated": "2020-12-11",
"certification_date": "2020-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.296468",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peru, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.