Active NPI
Dylan Gerald Luebbert
- Pharmacist
- Marshall, MO
National Provider Identifier
1396338299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2019031438
- Practice address
- 941 Cherokee Dr
Marshall, MO 65340-3617 - Phone
- (660) 226-5558
- NPI assigned
- Feb 11, 2021
- Last updated
- Feb 11, 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 | 2019031438 | MO | Primary |
Addresses
Primary practice location
941 Cherokee Dr
Marshall, MO 65340-3617
Mailing address
941 Cherokee Dr
Marshall, MO 65340-3617
Phone (660) 226-5558
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 |
|---|---|---|---|
| 2019031438 | MO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613001600000",
"number": "1396338299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "941 CHEROKEE DR",
"city": "MARSHALL",
"state": "MO",
"postal_code": "653403617",
"telephone_number": "660-226-5558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "941 CHEROKEE DR",
"city": "MARSHALL",
"state": "MO",
"postal_code": "653403617",
"telephone_number": "660-226-5558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUEBBERT",
"first_name": "DYLAN",
"middle_name": "GERALD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-11",
"last_updated": "2021-02-11",
"certification_date": "2021-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2019031438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marshall, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.