Douglas Gossen, R.PH.
Individual provider Active NPI Pharmacist · Minooka, IL
NPI 1972769321 · NPPES record last updated Aug 5, 2008
Key facts
- NPI
- 1972769321
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051035801 (IL)
- Practice address
- 2051 Ridge Rd
Minooka, IL 60447-8801 - Phone
- (815) 467-1254
- NPI assigned
- Aug 5, 2008
- Sex
- Male
- Sole proprietor
- No
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051035801 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Drug Stores LLC | Past | Accepting new patients | |
| American Drug Stores LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051035801 | IL | Yes |
Addresses
Primary practice location
2051 Ridge Rd
Minooka, IL 60447-8801
Mailing address
2051 Ridge Rd
Minooka, IL 60447-8801
Phone (815) 467-1254
Other providers in Minooka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2008. 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.