Jacob Dallas, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

S018634 Issued in AZ

Practice address

705 E McDowell Rd
Phoenix, AZ 85006-2519

Phone

(602) 258-4865

NPI assigned

Aug 12, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Walgreen Co

  • Pharmacy
  • Phoenix, AZ
  • NPI 1356356604
  NPD (past)

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313107200000",
    "number": "1619256286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N PRIEST DR",
            "address_2": "APT. 2024",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852261004",
            "telephone_number": "314-805-7586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 E MCDOWELL RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062519",
            "telephone_number": "602-258-4865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLAS",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-12",
        "last_updated": "2011-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S018634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dalia Homecare LLC
• Dalia Homecare Mariposa
• Jenna Dalla Mura
• Alexis Marie Dallacroce, BS
• Casey Dallas, PA
• Kyla Donmarie Dallas
• Leilani Dallas, R.D.
• Debra Ann Dallman, MS, BCBA, LBA
• Bruno Henrique Dallo Gallo
• Barbara Dalmazzo, PA-C

• Pharmacist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Pharmacist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2011; 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.