Sandy Dervisevic

Primary specialty

PharmacistTaxonomy code 183500000X

License

P10821 Issued in ID

Practice address

8300 W Overland Rd
Boise, ID 83709-1639

Phone

(208) 321-9080

NPI assigned

Aug 11, 2023

Last updated

Aug 11, 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

State licenses

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

{
    "created_epoch": "1691712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1326721606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6082 S TALLOWTREE WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837166966",
            "telephone_number": "208-598-2925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 W OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091639",
            "telephone_number": "208-321-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERVISEVIC",
        "first_name": "SANDY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-11",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P10821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dermaclinical, Inc.
• Olga Derman, M.D.
• Dermatology Clinic of Idaho
• David Deroin, MD
• Jayne Derr, LCSW
• Abhilash Desai
• Timothy Stephen Desantis, LCPC
• Raina Desha, DPT
• Cassidy Joy Deshazer, MSW, LCSW
• Michele Desilets-Reel, PA-C

• Pharmacist in Boise, ID
• Providers in Boise, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.