Active NPI
Derek Haynes
- Pharmacist
- Memphis, TN
National Provider Identifier
1255911442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 42051
- Practice address
- 3515 Park Ave
Memphis, TN 38111-5621 - Phone
- (901) 458-1611
- NPI assigned
- Apr 12, 2021
- 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 | 42051 | TN | Primary |
Addresses
Primary practice location
3515 Park Ave
Memphis, TN 38111-5621
Mailing address
3515 Park Ave
Memphis, TN 38111-5621
Phone (901) 458-1611
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | 9014581611 | ||
| Other URL | RXM.07613@store.walgreens.com |
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 |
|---|---|---|---|
| 42051 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618185600000",
"number": "1255911442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3515 PARK AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381115621",
"telephone_number": "901-458-1611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3515 PARK AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381115621",
"telephone_number": "901-458-1611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAYNES",
"first_name": "DEREK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-12",
"last_updated": "2021-04-12",
"certification_date": "2021-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "42051",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "9014581611",
"affiliation": "N",
"endpointDescription": "phone",
"address_1": "3515 Park Ave",
"city": "Memphis",
"state": "TN",
"country_code": "US",
"postal_code": "381115621",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "RXM.07613@store.walgreens.com",
"affiliation": "N",
"address_1": "3515 Park Ave",
"city": "Memphis",
"state": "TN",
"country_code": "US",
"postal_code": "381115621",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.