Active NPI
Nicholas Nzioka Ndetti Jr., PHARM D.
- Pharmacist
- Fairbanks, AK
National Provider Identifier
1396298626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 102370
- Practice address
- 1919 Lathrop St
Suite 109
Fairbanks, AK 99701-5937 - Phone
- (907) 452-1514
- Fax
- (907) 452-1917
- NPI assigned
- Aug 3, 2016
- 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 | 102370 | AK | Primary |
Addresses
Primary practice location
1919 Lathrop St
Suite 109
Fairbanks, AK 99701-5937
Mailing address
1919 Lathrop St
Suite 109
Fairbanks, AK 99701-5937
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 |
|---|---|---|---|
| 102370 | AK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471910400000",
"number": "1396298626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1919 LATHROP ST",
"address_2": "SUITE 109",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1919 LATHROP ST",
"address_2": "SUITE 109",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015937",
"telephone_number": "907-452-1514",
"fax_number": "907-452-1917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NDETTI",
"first_name": "NICHOLAS",
"middle_name": "NZIOKA",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PHARM D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-03",
"last_updated": "2016-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AK",
"license": "102370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.