Active NPI
Connor Aaron Dewalt
- Pharmacy Technician
- Lakewood, OH
National Provider Identifier
1689384976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 09216801
- Practice address
- 1310 Donald Ave
Lakewood, OH 44107-2851 - Phone
- (440) 226-1237
- NPI assigned
- Nov 29, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 09216801 | OH | Primary |
Addresses
Primary practice location
1310 Donald Ave
Lakewood, OH 44107-2851
Mailing address
1310 Donald Ave
Lakewood, OH 44107-2851
Phone (440) 226-1237
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 |
|---|---|---|---|
| 09216801 | OH | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669680000000",
"number": "1689384976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1310 DONALD AVE",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "441072851",
"telephone_number": "440-226-1237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 DONALD AVE",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "441072851",
"telephone_number": "440-226-1237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWALT",
"first_name": "CONNOR",
"middle_name": "AARON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-29",
"last_updated": "2022-11-29",
"certification_date": "2022-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "OH",
"license": "09216801",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.