NPIMap

Individual provider Active NPI

Jeffery Robert Proctor

  • Pharmacist
  • Thousand Oaks, CA
National Provider Identifier
1528368024
Registry record updated Aug 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
63884 Issued in CA
Practice address
2048 E Avenida de Los Arboles
Thousand Oaks, CA 91362-1356
Phone
(805) 492-3511
NPI assigned
Oct 30, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 63884 CA Primary

Addresses

Primary practice location

2048 E Avenida de Los Arboles
Thousand Oaks, CA 91362-1356

Mailing address

2048 E Avenida de Los Arboles
Thousand Oaks, CA 91362-1356
Phone (805) 492-3511

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

LicenseStateTypeSpecialty
63884CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Safeway Inc Past Accepting new patients
Safeway Inc Past Accepting new patients
Vons Companies Inc PastSince Aug 11, 2019 Accepting new patients

Organizations & group practices 3

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": "1288396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564876800000",
    "number": "1528368024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2048 E AVENIDA DE LOS ARBOLES",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913621356",
            "telephone_number": "805-492-3511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2048 E AVENIDA DE LOS ARBOLES",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913621356",
            "telephone_number": "805-492-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "JEFFERY",
        "middle_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-30",
        "last_updated": "2019-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "63884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2019; 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.