Active NPI
Kristin Lauren Deitle, PHARMD
- Pharmacist
- Myrtle Beach, SC
National Provider Identifier
1811245830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11940
- Practice address
- 1303 38TH Ave N
Myrtle Beach, SC 29577-1315 - Phone
- (843) 448-4437
- Fax
- (843) 946-9677
- NPI assigned
- Aug 23, 2012
- Sex
- Female
- 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 | 11940 | SC | Primary |
Addresses
Primary practice location
1303 38TH Ave N
Myrtle Beach, SC 29577-1315
Mailing address
1303 38TH Ave N
Myrtle Beach, SC 29577-1315
Phone (843) 448-4437
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 |
|---|---|---|---|
| 11940 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345680000000",
"number": "1811245830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1303 38TH AVE N",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295771315",
"telephone_number": "843-448-4437",
"fax_number": "843-946-9677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1303 38TH AVE N",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295771315",
"telephone_number": "843-448-4437",
"fax_number": "843-946-9677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEITLE",
"first_name": "KRISTIN",
"middle_name": "LAUREN",
"name_prefix": "Mrs.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-23",
"last_updated": "2012-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "11940",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.