Active NPI
Corey Michael Dietz, PHARMD
- Pharmacist
- Manitowoc, WI
National Provider Identifier
1831711837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18902-40
- Practice address
- 701 E Reed Ave
Manitowoc, WI 54220-2129 - Phone
- (920) 682-3726
- NPI assigned
- May 12, 2020
- Last updated
- May 12, 2020
- 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 | 18902-40 | WI | Primary |
Addresses
Primary practice location
701 E Reed Ave
Manitowoc, WI 54220-2129
Mailing address
701 E Reed Ave
Manitowoc, WI 54220-2129
Phone (920) 682-3726
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 |
|---|---|---|---|
| 18902-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin CVS Pharmacy LLC | Past | Accepting new patients | |
| Wisconsin CVS Pharmacy LLC | 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": "1589241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589241600000",
"number": "1831711837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 E REED AVE",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542202129",
"telephone_number": "920-682-3726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 E REED AVE",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542202129",
"telephone_number": "920-682-3726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "COREY",
"middle_name": "MICHAEL",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-12",
"last_updated": "2020-05-12",
"certification_date": "2020-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "18902-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.