Active NPI
Dominic Herrmann
- Pharmacist
- Jacksonville, NC
National Provider Identifier
1104334903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 23960
- Practice address
- 1395D Western Blvd
Jacksonville, NC 28546-6663 - Phone
- (937) 910-6639
- NPI assigned
- Jan 14, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pharmacist | 183500000X | 23960 | NC | Primary |
Addresses
Primary practice location
1395D Western Blvd
Jacksonville, NC 28546-6663
Mailing address
72 Acadian Loop Apt 305
Hampstead, NC 28443-0197
Phone (615) 477-0267
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 |
|---|---|---|---|
| 23960 | NC | MD | Oncology Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584403200000",
"number": "1104334903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 ACADIAN LOOP APT 305",
"city": "HAMPSTEAD",
"state": "NC",
"postal_code": "284430197",
"telephone_number": "615-477-0267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1395D WESTERN BLVD",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285466663",
"telephone_number": "937-910-6639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRMANN",
"first_name": "DOMINIC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-14",
"last_updated": "2020-03-17",
"certification_date": "2020-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "23960",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.