Active NPI
Shannon Dierker, RPH
- Pharmacist
- Ellisville, MO
National Provider Identifier
1760767297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 044017
- Practice address
- 1302 Clarkson Clayton Ctr
Ellisville, MO 63011-2145 - Phone
- (636) 394-4422
- NPI assigned
- Oct 16, 2011
- Last updated
- Oct 16, 2011
- 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 | 044017 | MO | Primary |
Addresses
Primary practice location
1302 Clarkson Clayton Ctr
Ellisville, MO 63011-2145
Mailing address
1302 Clarkson Clayton Ctr
Ellisville, MO 63011-2145
Phone (636) 394-4422
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318723200000",
"number": "1760767297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 CLARKSON CLAYTON CTR",
"city": "ELLISVILLE",
"state": "MO",
"postal_code": "630112145",
"telephone_number": "636-394-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 CLARKSON CLAYTON CTR",
"city": "ELLISVILLE",
"state": "MO",
"postal_code": "630112145",
"telephone_number": "636-394-4422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIERKER",
"first_name": "SHANNON",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-16",
"last_updated": "2011-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "044017",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellisville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.