Individual provider Active NPI

Greg Dieleman, PHARM D

  • Pharmacist
  • Pella, IA
National Provider Identifier
1770247199
Registry record updated Oct 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
20995 Issued in IA
Practice address
802 Washington St
Pella, IA 50219-1525
Phone
(641) 628-1612
Fax
(641) 620-0021
NPI assigned
Oct 22, 2021
Last updated
Oct 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 20995 IA Primary

Addresses

Primary practice location

802 Washington St
Pella, IA 50219-1525

Mailing address

802 Washington St
Pella, IA 50219-1525
Phone (641) 628-1612

Other practice location 1

404 E 2nd Street
Prairie City, IA 50228
Phone (515) 994-2618

Other practice location 2

405 Monroe St
Pella, IA 50219-1189
Phone (641) 621-2444

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
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
20995IAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634860800000",
    "number": "1770247199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 WASHINGTON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191525",
            "telephone_number": "641-628-1612",
            "fax_number": "641-620-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 WASHINGTON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191525",
            "telephone_number": "641-628-1612",
            "fax_number": "641-620-0021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "404 E 2nd Street",
            "address_purpose": "LOCATION",
            "city": "Prairie City",
            "state": "IA",
            "postal_code": "50228",
            "country_code": "US",
            "telephone_number": "515-994-2618",
            "fax_number": "515-994-3013",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Monroe St",
            "address_purpose": "LOCATION",
            "city": "Pella",
            "state": "IA",
            "postal_code": "502191189",
            "country_code": "US",
            "telephone_number": "641-621-2444",
            "fax_number": "641-628-2164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIELEMAN",
        "first_name": "GREG",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-22",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IA",
            "license": "20995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pella, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.