Alice Jessup Dedrick, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

026482 Issued in NY

Practice address

4900 Broadway
Depew, NY 14043-3934

Phone

(716) 681-4255

Fax

(716) 681-7598

NPI assigned

Nov 8, 2007

Last updated

Nov 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

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

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194480000000",
    "number": "1861672784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 TUNBRIDGE WALKE",
            "city": "EAST AURORA",
            "state": "NY",
            "postal_code": "140522019",
            "telephone_number": "716-652-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 BROADWAY",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140433934",
            "telephone_number": "716-681-4255",
            "fax_number": "716-681-7598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDRICK",
        "first_name": "ALICE",
        "middle_name": "JESSUP",
        "name_prefix": "Ms.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-08",
        "last_updated": "2007-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "026482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00482751",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Depew, NY
• Providers in Depew, NY by specialty
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; 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.