Active NPI
Diedra Dourth, PHARMD
- Pharmacist
- Fayetteville, AR
National Provider Identifier
1588264758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD13529
- Practice address
- 2875 W Martin Luther King Blvd
Fayetteville, AR 72704-7625 - Phone
- (479) 521-4350
- NPI assigned
- Oct 27, 2020
- Sex
- Female
- 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 | PD13529 | AR | Primary |
Addresses
Primary practice location
2875 W Martin Luther King Blvd
Fayetteville, AR 72704-7625
Mailing address
2875 W Martin Luther King Blvd
Fayetteville, AR 72704-7625
Phone (479) 521-4350
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PD13529 | Other | AR | STATE LICENSE |
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 |
|---|---|---|---|
| PD13529 | AR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1588264758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2875 W MARTIN LUTHER KING BLVD",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727047625",
"telephone_number": "479-521-4350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2875 W MARTIN LUTHER KING BLVD",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727047625",
"telephone_number": "479-521-4350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOURTH",
"first_name": "DIEDRA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-27",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD13529",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PD13529",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.