Active NPI
Samantha Dedrick
- Pharmacist
- St Petersburg, FL
National Provider Identifier
1710405766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS56612
- Practice address
- 10496 Roosevelt Blvd N
Saint Petersburg, FL 33716-3820 - Phone
- (727) 576-5858
- NPI assigned
- Aug 30, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS56612 | FL | Primary |
Addresses
Primary practice location
10496 Roosevelt Blvd N
Saint Petersburg, FL 33716-3820
Mailing address
540 Carillon Pkwy Apt 1052
Saint Petersburg, FL 33716-1213
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 |
|---|---|---|---|
| PS56612 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Publix Super Markets Inc | Past | Accepting new patients | |
| Publix Super Markets Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Publix Pharmacy #0395
- Community/Retail Pharmacy
- St Petersburg, FL
- NPI 1396295184
-
dba Publix Pharmacy #2107
- Community/Retail Pharmacy
- Winter Haven, FL
- NPI 1760356380
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504051200000",
"number": "1710405766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 CARILLON PKWY APT 1052",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337161213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10496 ROOSEVELT BLVD N",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337163820",
"telephone_number": "727-576-5858"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDRICK",
"first_name": "SAMANTHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-30",
"last_updated": "2017-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS56612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
- John B Decosmo, DO
- Dedicated Senior Medical Center St. Petersburg, LLC.
- Dedicated Senior Medical Centers of Florida, LLC (Dedicated Senior Medical Center Kenneth City)
- Dedicated Senior Medical Centers of Florida, LLC (Dedicated Senior Medical Center Lealman)
- Dedra Hern Crna LLC
- Megan Deedrich, FNP-BC
- Savannah Nicole Deering, RD
- Ivy Defelix, RN
- Stella M Defortuna, MD
- Daniel Defrank
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.