Active NPI
James Derderian, PHARMD.
- Pharmacist
- Pawtucket, RI
National Provider Identifier
1336424118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 04856
- Practice address
- 100 Broad St
Pawtucket, RI 02860 - Phone
- (401) 724-6724
- NPI assigned
- Oct 12, 2011
- Last updated
- Oct 12, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 04856 | RI | Primary |
| Pharmacist | 183500000X | 232948 | MA |
Addresses
Primary practice location
100 Broad St
Pawtucket, RI 02860
Mailing address
100 Broad St
Pawtucket, RI 02860
Phone (401) 724-6724
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 232948 | MA | MD | Pharmacist |
| 04856 | RI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318377600000",
"number": "1336424118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BROAD ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "02860",
"telephone_number": "401-724-6724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BROAD ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "02860",
"telephone_number": "401-724-6724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERDERIAN",
"first_name": "JAMES",
"credential": "PHARMD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-12",
"last_updated": "2011-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "RI",
"license": "04856",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "232948",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pawtucket, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.