Active NPI
Spencer Louis Dietz, PHARMD, RPH
- Pharmacist
- Ammon, ID
National Provider Identifier
1073079281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P5827
- Practice address
- 3250 E 17TH St
Ammon, ID 83406-6758 - Phone
- (208) 552-7677
- NPI assigned
- Feb 12, 2019
- 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 | P5827 | ID | Primary |
Addresses
Primary practice location
3250 E 17TH St
Ammon, ID 83406-6758
Mailing address
3270 E 17TH St # 130
Ammon, ID 83406-6758
Phone (208) 569-5839
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, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P5827 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549929600000",
"number": "1073079281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3270 E 17TH ST # 130",
"city": "AMMON",
"state": "ID",
"postal_code": "834066758",
"telephone_number": "208-569-5839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3250 E 17TH ST",
"city": "AMMON",
"state": "ID",
"postal_code": "834066758",
"telephone_number": "208-552-7677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "SPENCER",
"middle_name": "LOUIS",
"credential": "PHARMD, RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-12",
"last_updated": "2019-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P5827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ammon, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.