Individual provider Active NPI

Joseph Thomas Dutko, PHARMD

  • Pharmacist
  • Jefferson City, MO
National Provider Identifier
1588488654
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
2024044742 Issued in MO
Practice address
401 Supercenter Dr
Jefferson City, MO 65101-8190
Phone
(573) 635-3877
NPI assigned
Nov 14, 2024
Last updated
Nov 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 2024044742 MO Primary

Addresses

Primary practice location

401 Supercenter Dr
Jefferson City, MO 65101-8190

Mailing address

3625 Briarmont Ave Apt 210
Columbia, MO 65201-3680
Phone (330) 635-3482

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

LicenseStateTypeSpecialty
2024044742MOMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1588488654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 BRIARMONT AVE APT 210",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652013680",
            "telephone_number": "330-635-3482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 SUPERCENTER DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651018190",
            "telephone_number": "573-635-3877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTKO",
        "first_name": "JOSEPH",
        "middle_name": "THOMAS",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-14",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2024044742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; 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.