Active NPI
Patrick Demello
- Pharmacist
- Surprise, AZ
National Provider Identifier
1003210857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S020894
- Practice address
- 15514 W Waddell Rd
Surprise, AZ 85379-5167 - Phone
- (625) 321-5054
- NPI assigned
- Oct 21, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | S020894 | AZ | Primary |
Addresses
Primary practice location
15514 W Waddell Rd
Surprise, AZ 85379-5167
Mailing address
17600 N 79TH Ave Apt 624
Glendale, AZ 85308-8685
Phone (310) 819-7056
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S020894 | AZ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413849600000",
"number": "1003210857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17600 N 79TH AVE APT 624",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088685",
"telephone_number": "310-819-7056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15514 W WADDELL RD",
"city": "SURPRISE",
"state": "AZ",
"postal_code": "853795167",
"telephone_number": "625-321-5054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMELLO",
"first_name": "PATRICK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-21",
"last_updated": "2014-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S020894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Surprise, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.