Active NPI
Derek Smernes
- Pharmacist
- Ceres, CA
National Provider Identifier
1629532213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 57222
- Practice address
- 2929 4TH St
Ceres, CA 95307-3290 - Phone
- (209) 537-0718
- Fax
- (209) 537-4252
- NPI assigned
- Jan 28, 2019
- 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 | 57222 | CA | Primary |
Addresses
Primary practice location
2929 4TH St
Ceres, CA 95307-3290
Mailing address
2929 4TH St
Ceres, CA 95307-3290
Phone (209) 537-0718
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57222 | Other | CA | CALIFORNIA STATE BOARD OF PHARMACY |
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 |
|---|---|---|---|
| 57222 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ceres Drug Store, Inc. | Current | Accepting new patients |
Locations
2929 4th St
Ceres, CA 95307
Phone (209) 537-0718
Organizations & group practices 1
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": "1548633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617840000000",
"number": "1629532213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 4TH ST",
"city": "CERES",
"state": "CA",
"postal_code": "953073290",
"telephone_number": "209-537-0718",
"fax_number": "209-537-4252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2929 4TH ST",
"city": "CERES",
"state": "CA",
"postal_code": "953073290",
"telephone_number": "209-537-0718",
"fax_number": "209-537-4252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMERNES",
"first_name": "DEREK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-28",
"last_updated": "2021-04-08",
"certification_date": "2021-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "57222",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA STATE BOARD OF PHARMACY",
"identifier": "57222",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ceres, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.