Active NPI
Derrick D Darbouze
- Pharmacist
- Pennsauken, NJ
National Provider Identifier
1710411970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI03853300
- Practice address
- 4601 Westfield Ave
Pennsauken, NJ 08110-3029 - Phone
- (856) 663-3405
- NPI assigned
- Apr 14, 2017
- Last updated
- Apr 14, 2017
- 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 | 28RI03853300 | NJ | Primary |
Addresses
Primary practice location
4601 Westfield Ave
Pennsauken, NJ 08110-3029
Mailing address
1901 Callowhill St
Apt 219
Philadelphia, PA 19130-4150
Phone (201) 458-4488
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 |
|---|---|---|---|
| 28RI03853300 | NJ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Retail Pharmacy
- Philadelphia, PA
- NPI 1366000564
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1492128000000",
"number": "1710411970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 CALLOWHILL ST",
"address_2": "APT 219",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191304150",
"telephone_number": "201-458-4488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 WESTFIELD AVE",
"city": "PENNSAUKEN",
"state": "NJ",
"postal_code": "081103029",
"telephone_number": "856-663-3405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DARBOUZE",
"first_name": "DERRICK",
"middle_name": "D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-14",
"last_updated": "2017-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03853300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pennsauken, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.