Active NPI
Northern Arizona Pharmacy LLC
Doing business as Dewey Pharmacy
- Community/Retail Pharmacy
- Dewey, AZ
National Provider Identifier
1902445802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- NORTHERN ARIZONA PHARMACY LLC
- Doing business as
- Dewey Pharmacy
- Practice address
- 12075 E State Route 69
Suite E
Dewey, AZ 86327 - Phone
- (928) 515-0455
- Fax
- (928) 515-0456
- NPI assigned
- Dec 26, 2019
- Last updated
- Dec 8, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jason James Dykstra, PHARMD
- Title
- Manager
- Phone
- (928) 515-0046
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
12075 E State Route 69
Suite E
Dewey, AZ 86327
Mailing address
1932 N State Route 89
Chino Valley, AZ 86323-5643
Phone (928) 515-0046
Other practice location 1
12075 E State Route 89
Suite A
Prescott Valley, AZ 86314
Phone (928) 515-0046
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003672 | Medicaid | AZ |
Other names 1
- Dewey Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170727002043 | AZ | Part B Supplier - Mass Immunization (Roster Biller Only) | 9234409939 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chino Valley, AZ; Dewey, AZ; Mayer, AZ |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Chino Valley Pharmacy
- Pharmacy
- Chino Valley, AZ
- NPI 1194175588
O20170727002043
-
dba Cordes Pharmacy
- Community/Retail Pharmacy
- Cordes Lakes, AZ
- NPI 1669060166
O20170727002043
National Provider Directory
National Provider Directory- Tax ID family
- Dewey Pharmacy
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Cordes Pharmacy
- Community/Retail Pharmacy
- Cordes Lakes, AZ
- NPI 1669060166
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Chino Valley, AZ
- NPI 1801126024
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577318400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607385600000",
"number": "1902445802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1932 N STATE ROUTE 89",
"city": "CHINO VALLEY",
"state": "AZ",
"postal_code": "863235643",
"telephone_number": "928-515-0046",
"fax_number": "928-515-0047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12075 E STATE ROUTE 69",
"address_2": "SUITE E",
"city": "DEWEY",
"state": "AZ",
"postal_code": "86327",
"telephone_number": "928-515-0455",
"fax_number": "928-515-0456"
}
],
"practiceLocations": [
{
"address_1": "12075 E State Route 89",
"address_2": "Suite A",
"address_purpose": "LOCATION",
"city": "Prescott Valley",
"state": "AZ",
"postal_code": "86314",
"country_code": "US",
"telephone_number": "928-515-0046",
"fax_number": "928-515-0047",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "NORTHERN ARIZONA PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-12-26",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A",
"authorized_official_last_name": "DYKSTRA",
"authorized_official_first_name": "JASON",
"authorized_official_middle_name": "JAMES",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "928-515-0046",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003672",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Dewey Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Dewey Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dewey, AZ
- Monreal Family Services, LLC
- Toni L Monreal, LCSW
- Keri Newberry
- Cindy Kay Noble
- Northern Arizona Pharmacy (Dewey Pharmacy)
- Candace Oen, P. A. -C.
- Frederic Leland Ondovchak, R.N., M.S.N., A.P.R.
- Angela Payne, LPN
- Prescott Renal Care Group, LLC (Renal Care Group Prescott)
- Quad City Medical Associate, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.