Active NPI
Derk Penrod, PHARMD
- Pharmacist
- Seaside, OR
National Provider Identifier
1952735987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0013656
- Practice address
- 401 S Roosevelt
Seaside, OR 97138 - Phone
- (503) 738-4706
- NPI assigned
- Aug 27, 2013
- Last updated
- Aug 27, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0013656 | OR | Primary |
| Pharmacist | 183500000X | 2079 | AK | |
| Pharmacist | 183500000X | 120777 | MN |
Addresses
Primary practice location
401 S Roosevelt
Seaside, OR 97138
Mailing address
PO Box 1177
Seaside, OR 97138
Phone (801) 842-3607
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 |
|---|---|---|---|
| 2079 | AK | MD | Pharmacist |
| 120777 | MN | MD | Pharmacist |
| 0013656 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377561600000",
"number": "1952735987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1177",
"city": "SEASIDE",
"state": "OR",
"postal_code": "97138",
"telephone_number": "801-842-3607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 S ROOSEVELT",
"city": "SEASIDE",
"state": "OR",
"postal_code": "97138",
"telephone_number": "503-738-4706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENROD",
"first_name": "DERK",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-27",
"last_updated": "2013-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "0013656",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AK",
"license": "2079",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "120777",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seaside, OR
- Arne Dean Otness, DC
- Margo E Pabst, CADC II, NCACII
- Julie A Paquette, MD
- Aydan William Parsons, DPT, PT
- Ravindra R Patil, M.D., PHD
- Seth Richard Perkins
- Gregory John Pigeon, CRNA
- Providence Health & Services - Oregon (Providence Seaside Hospital)
- Providence Health & Services Oregon (Providence Seaside Hospital)
- Providence Health & Services Oregon (Providence Seaside Hospital)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.