Active NPI
Daniel Deornellas, PHARM.D.
- Pharmacist
- Jackson, MS
National Provider Identifier
1790066272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD11724
- Practice address
- 1500 E Woodrow Wilson Ave
Pharmacy Service (119)
Jackson, MS 39216-5116 - Phone
- (601) 362-4471
- NPI assigned
- Aug 29, 2011
- 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 | PD11724 | AR | Primary |
Addresses
Primary practice location
1500 E Woodrow Wilson Ave
Pharmacy Service (119)
Jackson, MS 39216-5116
Mailing address
1500 E Woodrow Wilson Ave
Pharmacy Service (119)
Jackson, MS 39216-5116
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
| License | State | Type | Specialty |
|---|---|---|---|
| PD11724 | AR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314576000000",
"number": "1790066272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 E WOODROW WILSON AVE",
"address_2": "PHARMACY SERVICE (119)",
"city": "JACKSON",
"state": "MS",
"postal_code": "392165116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 E WOODROW WILSON AVE",
"address_2": "PHARMACY SERVICE (119)",
"city": "JACKSON",
"state": "MS",
"postal_code": "392165116",
"telephone_number": "601-362-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEORNELLAS",
"first_name": "DANIEL",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-29",
"last_updated": "2011-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD11724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.