Active NPI
Trevor Dschaak
- Pharmacist
- Burley, ID
National Provider Identifier
1205220589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P7047
- Practice address
- 385 N Overland Ave
Burley, ID 83318-3432 - Phone
- (208) 677-4804
- NPI assigned
- Mar 24, 2015
- Last updated
- Mar 24, 2015
- Sex
- Male
- 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 | P7047 | ID | Primary |
Addresses
Primary practice location
385 N Overland Ave
Burley, ID 83318-3432
Mailing address
385 N Overland Ave
Burley, ID 83318-3432
Phone (208) 677-4804
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 |
|---|---|---|---|
| P7047 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1427155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427155200000",
"number": "1205220589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "385 N OVERLAND AVE",
"city": "BURLEY",
"state": "ID",
"postal_code": "833183432",
"telephone_number": "208-677-4804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "385 N OVERLAND AVE",
"city": "BURLEY",
"state": "ID",
"postal_code": "833183432",
"telephone_number": "208-677-4804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DSCHAAK",
"first_name": "TREVOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-24",
"last_updated": "2015-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P7047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.