Theresa Dextraze, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

PH25184 Issued in MA

Practice address

255 Warner Blvd
Taunton, MA 02780-8300

Phone

(508) 824-1057

Fax

(508) 822-0140

NPI assigned

Nov 30, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1225633274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CAMERON DR",
            "city": "DIGHTON",
            "state": "MA",
            "postal_code": "027151532",
            "telephone_number": "774-872-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 WARNER BLVD",
            "city": "TAUNTON",
            "state": "MA",
            "postal_code": "027808300",
            "telephone_number": "508-824-1057",
            "fax_number": "508-822-0140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEXTRAZE",
        "first_name": "THERESA",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-30",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MA",
            "license": "PH25184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "hannaford",
            "affiliation": "Y",
            "endpointDescription": "work email",
            "affiliationName": "Victory Distributors LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "work email",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "255 JOSEPH E WARNER BLVD",
            "city": "TAUNTON",
            "state": "MA",
            "country_code": "US",
            "postal_code": "02780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristy Lee Desouza, B.S.
• Denise Marguerite Desrosiers, OTR/L
• Catherine Marie Devine, CEIS
• George C. Devlin, LICSW
• Elizabeth Devolve
• Nicole Dezan, M.S.
• Muttaqi Dhulkifl
• Aleksander Diarbian
• Alicia Dias
• Jualina M Diaz, BS

• Pharmacist in Taunton, MA
• Providers in Taunton, MA by specialty
• Pharmacist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.

Verify at the official NPI Registry.