Derek Staradub I

Primary specialty

PharmacistTaxonomy code 183500000X

License

PHCY-01388 Issued in NH

Practice address

53 Hooksett Rd
Manchester, NH 03104-2601

Phone

(603) 623-1135

NPI assigned

Aug 29, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maxi Drug North Inc

  • Community/Retail Pharmacy
  • Laconia, NH
  • NPI 1275632556
  NPD (past)
• Maxi Drug North Inc

  • Community/Retail Pharmacy
  • Manchester, NH
  • NPI 1891894168
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1013637479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 BLACKSTONE CT",
            "city": "MERRIMACK",
            "state": "NH",
            "postal_code": "030543451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 HOOKSETT RD",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031042601",
            "telephone_number": "603-623-1135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARADUB",
        "first_name": "DEREK",
        "name_suffix": "I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-29",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NH",
            "license": "PHCY-01388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Charles Raymond Stanton
• Chantel Denise Staples
• Brenna C. Stapp, D.O.
• Shawn Wesley Stapp, D.O.
• Kremena V Star, M.D.
• Starlight ABA NH LLC
• Gale Smith Starr, LICSW
• State of New Hampshire
• Stay Mobile Physical Therapy PLLC
• Angela Stayduhar

• Pharmacist in Manchester, NH
• Providers in Manchester, NH by specialty
• Pharmacist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; 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.