Jacqueline June Diercks, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

PH00068563 Issued in WA

Practice address

4111 194TH St SW
Lynnwood, WA 98036-4604

Phone

(425) 835-5202

Fax

(425) 835-5203

NPI assigned

Jun 14, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565654400000",
    "number": "1770878076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 194TH ST SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364604",
            "telephone_number": "425-835-5202",
            "fax_number": "425-835-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 194TH ST SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364604",
            "telephone_number": "425-835-5202",
            "fax_number": "425-835-5203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2320 Freeway Dr",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "WA",
            "postal_code": "982735445",
            "country_code": "US",
            "telephone_number": "360-814-6840",
            "fax_number": "360-814-6925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIERCKS",
        "first_name": "JACQUELINE",
        "middle_name": "JUNE",
        "name_prefix": "Mrs.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-14",
        "last_updated": "2019-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "WA",
            "license": "PH00068563",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00068563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lourdes Diaz Monroy
• Heather I Diaz, LMHC
• Johanna Nicole Dibble, RD
• Deanna Irene Dickerman, M.D.
• Micayla Didilescu, MS, OTR/L
• Valerie Lynne Dillon, MA
• Karen Dixon
• Milea Magtoto Dizon
• Hee Jeong DO, D.C.
• Kathy Doan, MSN, MPH, ARNP

• Pharmacist in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; 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.