Active NPI
Dylan Pack
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Virginia Beach, VA
National Provider Identifier
1477077105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 0202216015
- Practice address
- 4625 Shore Dr
Virginia Beach, VA 23455-2745 - Phone
- (757) 640-1674
- NPI assigned
- Aug 3, 2017
- Last updated
- Jan 14, 2020
- 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 | 0202216015 | VA | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 0202216015 | VA | Primary |
Addresses
Primary practice location
4625 Shore Dr
Virginia Beach, VA 23455-2745
Mailing address
4816 Harbor Oaks Way
Virginia Beach, VA 23455-1944
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 |
|---|---|---|---|
| 0202216015 | VA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578960000000",
"number": "1477077105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4816 HARBOR OAKS WAY",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234551944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4625 SHORE DR",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234552745",
"telephone_number": "757-640-1674"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACK",
"first_name": "DYLAN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-03",
"last_updated": "2020-01-14",
"certification_date": "2020-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202216015",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "VA",
"license": "0202216015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.