Active NPI
Derrick Dorsey
- Pharmacist
- Modesto, CA
National Provider Identifier
1063002020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 83468
- Practice address
- 2101 E Hatch Rd
Modesto, CA 95351-4814 - Phone
- (209) 538-8268
- NPI assigned
- Jan 24, 2021
- Sex
- Male
- 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 | 83468 | CA | Primary |
Addresses
Primary practice location
2101 E Hatch Rd
Modesto, CA 95351-4814
Mailing address
1924 Hunt Ave
Modesto, CA 95350-1952
Phone (209) 818-6475
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 |
|---|---|---|---|
| 83468 | CA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pharmacy
- Modesto, CA
- NPI 1952317513
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611446400000",
"number": "1063002020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1924 HUNT AVE",
"city": "MODESTO",
"state": "CA",
"postal_code": "953501952",
"telephone_number": "209-818-6475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 E HATCH RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953514814",
"telephone_number": "209-538-8268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORSEY",
"first_name": "DERRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-24",
"last_updated": "2021-01-24",
"certification_date": "2021-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "83468",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.