Active NPI
Klair Diedrick
- Pharmacist
- Appleton, WI
National Provider Identifier
1154930790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20393
- Practice address
- 3701 E Calumet St
Appleton, WI 54915-4149 - Phone
- (920) 996-0746
- NPI assigned
- Jul 29, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20393 | WI | Primary |
Addresses
Primary practice location
3701 E Calumet St
Appleton, WI 54915-4149
Mailing address
2917 Southbreeze CT
Kaukauna, WI 54130-3587
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 |
|---|---|---|---|
| 20393 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595980800000",
"number": "1154930790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2917 SOUTHBREEZE CT",
"city": "KAUKAUNA",
"state": "WI",
"postal_code": "541303587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3701 E CALUMET ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549154149",
"telephone_number": "920-996-0746"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIEDRICK",
"first_name": "KLAIR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-29",
"last_updated": "2020-07-29",
"certification_date": "2020-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "20393",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 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.