Individual provider Active NPI

Sereke Adam Zerayesus, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Chicago, IL
National Provider Identifier
1982290011
Registry record updated Dec 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X
License
051303644 Issued in IL
Practice address
2434 N Sacramento Ave
Chicago, IL 60647-2666
Phone
(773) 687-6346
NPI assigned
Dec 13, 2020
Last updated
Dec 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 051303644 IL Primary

Addresses

Primary practice location

2434 N Sacramento Ave
Chicago, IL 60647-2666

Mailing address

2434 N Sacramento Ave
Chicago, IL 60647-2666
Phone (773) 687-6346

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

LicenseStateTypeSpecialty
051303644ILMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Highland Park CVS LLC CurrentSince Dec 16, 2020 Accepting new patients

Locations

2434 N Sacramento Ave
Chicago, IL 60647
Phone (773) 687-6346

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": "1607817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607817600000",
    "number": "1982290011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2434 N SACRAMENTO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472666",
            "telephone_number": "773-687-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2434 N SACRAMENTO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472666",
            "telephone_number": "773-687-6346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZERAYESUS",
        "first_name": "SEREKE",
        "middle_name": "ADAM",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-13",
        "last_updated": "2020-12-13",
        "certification_date": "2020-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "IL",
            "license": "051303644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.

Verify at the official NPI Registry.