Active NPI
Bradley Wayne Dedmon, P.D.
- Pharmacist
- Spiro, OK
National Provider Identifier
1497881098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12538
- Practice address
- 213 W Broadway St
Spiro, OK 74959-2419 - Phone
- (918) 962-2131
- Fax
- (918) 962-5750
- NPI assigned
- Feb 26, 2007
- Last updated
- Jul 8, 2007
- 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 | 12538 | OK | Primary |
Addresses
Primary practice location
213 W Broadway St
Spiro, OK 74959-2419
Mailing address
213 W Broadway St
Spiro, OK 74959-2419
Phone (918) 962-2131
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 |
|---|---|---|---|
| 12538 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dedmon Pharmacy Inc | Current | Accepting new patients | |
| Dedmon Pharmacy Inc | Current | Accepting new patients |
Locations
213 W Broadway St
Spiro, OK 74959
Phone (918) 962-2131
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Long Term Care Pharmacy
- Spiro, OK
- NPI 1326508706
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497881098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "213 W BROADWAY ST",
"city": "SPIRO",
"state": "OK",
"postal_code": "749592419",
"telephone_number": "918-962-2131",
"fax_number": "918-962-5750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "213 W BROADWAY ST",
"city": "SPIRO",
"state": "OK",
"postal_code": "749592419",
"telephone_number": "918-962-2131",
"fax_number": "918-962-5750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDMON",
"first_name": "BRADLEY",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "P.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "12538",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spiro, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.