Eric Daniel Dierkes, RPH
Individual provider Active NPI Pharmacist · Ada, OH
NPI 1154949998 · NPPES record last updated Jul 8, 2020
Key facts
- NPI
- 1154949998
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 03439839 (OH)
- Practice address
- 525 S Main St
Ada, OH 45810-6000 - Phone
- (419) 772-2299
- NPI assigned
- Jul 8, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03439839 | OH | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03439839 | OH | Yes |
Addresses
Primary practice location
525 S Main St
Ada, OH 45810-6000
Mailing address
525 S Main St
Ada, OH 45810-6000
Phone (419) 772-2299
Other providers in Ada, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.