Justin Roderick, PHARMD

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Practice address

21202 24TH Ave S
Des Moines, WA 98198-4328

Phone

(206) 767-1347

NPI assigned

Apr 27, 2023

Last updated

Apr 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

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

{
    "created_epoch": "1682553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682553600000",
    "number": "1174211015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 CEDAR ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981215200",
            "telephone_number": "207-270-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21202 24TH AVE S",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981984328",
            "telephone_number": "206-767-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODERICK",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-27",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Safeway Inc (Safeway Pharmacy #3540)

• Community/Retail Pharmacy in Des Moines, WA
• Providers in Des Moines, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.

Verify at the official NPI Registry.