Active NPI
Nicole Christina Dziuba, PHARMD
- Pharmacist
- Macomb, IL
National Provider Identifier
1063922334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS57090
- Practice address
- 533 E Grant Street
Macomb, IL 61455 - Phone
- (516) 639-8151
- NPI assigned
- Oct 2, 2017
- Sex
- Female
- 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 | PS57090 | FL | Primary |
Addresses
Primary practice location
533 E Grant Street
Macomb, IL 61455
Mailing address
6 Marty LN
Macomb, IL 61455-9504
Phone (516) 639-8151
Other practice location 1
525 E Grant St
Macomb, IL 61455-3318
Phone (516) 639-8151
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
| License | State | Type | Specialty |
|---|---|---|---|
| PS57090 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731974400000",
"number": "1063922334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 MARTY LN",
"city": "MACOMB",
"state": "IL",
"postal_code": "614559504",
"telephone_number": "516-639-8151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "533 E GRANT STREET",
"city": "MACOMB",
"state": "IL",
"postal_code": "61455",
"telephone_number": "516-639-8151"
}
],
"practiceLocations": [
{
"address_1": "525 E Grant St",
"address_purpose": "LOCATION",
"city": "Macomb",
"state": "IL",
"postal_code": "614553318",
"country_code": "US",
"telephone_number": "516-639-8151",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DZIUBA",
"first_name": "NICOLE",
"middle_name": "CHRISTINA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-10-02",
"last_updated": "2024-11-19",
"certification_date": "2024-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS57090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.