NPIMap

Individual provider Active NPI

Zachary Ryan Davidson, R.PH.

  • Pharmacist
  • Council Bluffs, IA
National Provider Identifier
1366719478
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
20506 Issued in IA
Practice address
535 E Broadway
Council Bluffs, IA 51503-4419
Phone
(712) 329-0930
NPI assigned
Nov 18, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 20506 IA Primary
Pharmacist 183500000X 12861 NE

Addresses

Primary practice location

535 E Broadway
Council Bluffs, IA 51503-4419

Mailing address

535 E Broadway
Council Bluffs, IA 51503-4419
Phone (712) 329-0930

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
12861NEMDPharmacist
20506IAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1366719478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034419",
            "telephone_number": "712-329-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034419",
            "telephone_number": "712-329-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "ZACHARY",
        "middle_name": "RYAN",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-18",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "20506",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NE",
            "license": "12861",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.

Verify at the official NPI Registry.