Individual provider Active NPI

Troy Roddam, PHARMD

  • Pharmacist
  • Peoria, AZ
National Provider Identifier
1134725161
Registry record updated Dec 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
S022910 Issued in AZ
Practice address
10741 W El Cortez PL Apt 2168
Peoria, AZ 85383-9627
Phone
(602) 320-8181
NPI assigned
Dec 6, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X S022910 AZ Primary

Addresses

Primary practice location

10741 W El Cortez PL Apt 2168
Peoria, AZ 85383-9627

Mailing address

10741 W El Cortez PL Apt 2168
Peoria, AZ 85383-9627
Phone (602) 320-8181

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

LicenseStateTypeSpecialty
S022910AZMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607212800000",
    "number": "1134725161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10741 W EL CORTEZ PL APT 2168",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853839627",
            "telephone_number": "602-320-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10741 W EL CORTEZ PL APT 2168",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853839627",
            "telephone_number": "602-320-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODDAM",
        "first_name": "TROY",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-06",
        "last_updated": "2020-12-06",
        "certification_date": "2020-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S022910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.

Verify at the official NPI Registry.