Active NPI
Nickolas Deitz, PHARMD
- Pharmacist
- Fort Lauderdale, FL
National Provider Identifier
1124677166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS59778
- Practice address
- 1415 E Sunrise Blvd
Fort Lauderdale, FL 33304-2324 - Phone
- (954) 888-8915
- NPI assigned
- Sep 11, 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 | PS59778 | FL | Primary |
Addresses
Primary practice location
1415 E Sunrise Blvd
Fort Lauderdale, FL 33304-2324
Mailing address
3404 Davie Rd Apt 403
Davie, FL 33314-1629
Phone (614) 581-5957
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 |
|---|---|---|---|
| PS59778 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568160000000",
"number": "1124677166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3404 DAVIE RD APT 403",
"city": "DAVIE",
"state": "FL",
"postal_code": "333141629",
"telephone_number": "614-581-5957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 E SUNRISE BLVD",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333042324",
"telephone_number": "954-888-8915"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEITZ",
"first_name": "NICKOLAS",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-11",
"last_updated": "2019-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS59778",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.