Active NPI
Derek Tea
- Pharmacist
- Laveen, AZ
National Provider Identifier
1922697085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S024816
- Practice address
- 5115 W Baseline Rd
Laveen, AZ 85339-3000 - Phone
- (602) 283-1603
- NPI assigned
- Jan 13, 2021
- 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 | S024816 | AZ | Primary |
Addresses
Primary practice location
5115 W Baseline Rd
Laveen, AZ 85339-3000
Mailing address
5151 N 16TH St Apt 4038
Phoenix, AZ 85016-3817
Phone (562) 685-1927
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S024816 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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 and National Provider Directory roles.
-
- Pharmacy
- Laveen, AZ
- NPI 1073665774
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611100800000",
"number": "1922697085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5151 N 16TH ST APT 4038",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850163817",
"telephone_number": "562-685-1927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5115 W BASELINE RD",
"city": "LAVEEN",
"state": "AZ",
"postal_code": "853393000",
"telephone_number": "602-283-1603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEA",
"first_name": "DEREK",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-13",
"last_updated": "2021-01-20",
"certification_date": "2021-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S024816",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laveen, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.