Active NPI
Tallie Pederson, PHARMD
- Pharmacist
- Akron, OH
National Provider Identifier
1144503467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03236389
- Practice address
- 375 S Main St
Akron, OH 44311-1013 - Phone
- (330) 622-5396
- Fax
- (330) 622-5398
- NPI assigned
- Sep 22, 2011
- Last updated
- Jun 8, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 17431 | NV | |
| Pharmacist | 183500000X | 03236389 | OH | Primary |
Addresses
Primary practice location
375 S Main St
Akron, OH 44311-1013
Mailing address
375 S Main St
Akron, OH 44311-1013
Phone (330) 622-5396
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 |
|---|---|---|---|
| 17431 | NV | MD | Pharmacist |
| 03236389 | OH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686182400000",
"number": "1144503467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 S MAIN ST",
"city": "AKRON",
"state": "OH",
"postal_code": "443111013",
"telephone_number": "330-622-5396",
"fax_number": "330-622-5398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 S MAIN ST",
"city": "AKRON",
"state": "OH",
"postal_code": "443111013",
"telephone_number": "330-622-5396",
"fax_number": "330-622-5398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "TALLIE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-22",
"last_updated": "2023-06-08",
"certification_date": "2023-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "17431",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03236389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Akron, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.