Active NPI
Dustin Anthony Dedecker, RPH
- Pharmacist
- Phoenix, AZ
National Provider Identifier
1720504368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S022750
- Practice address
- 3933 E Camelback Rd
Phoenix, AZ 85018-2609 - Phone
- (602) 956-2494
- NPI assigned
- Aug 15, 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 | S022750 | AZ | Primary |
Addresses
Primary practice location
3933 E Camelback Rd
Phoenix, AZ 85018-2609
Mailing address
19318 N 62ND Dr
Glendale, AZ 85308-7660
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S022750 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| German Dobson CVS LLC | Past | Accepting new patients | |
| German Dobson CVS LLC | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502755200000",
"number": "1720504368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19318 N 62ND DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853087660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3933 E CAMELBACK RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850182609",
"telephone_number": "602-956-2494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEDECKER",
"first_name": "DUSTIN",
"middle_name": "ANTHONY",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-15",
"last_updated": "2017-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S022750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
- Lanny Aven Decker, D.C.
- Madison Decker, M.S. CCC-SLP
- Yvette Jean Decker
- Nadia Lupe Declay, RN
- Mari'Yell Declouette-Sanders
- Dedicated Dragonfly Therapy, LLC
- Dedicated Onsite Therapy LLC
- Dedicated Recovery and Counseling LLC
- Dedicated Therapy Services LLC (Dedicated Therapy Service LLC)
- Brian Dedinsky, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.