Individual provider Active NPI

Nicolas Triana-Baltzer, RPH

  • Pharmacist
  • Eureka, CA
National Provider Identifier
1982461679
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
75990 Issued in CA
Practice address
1424 Broadway
Eureka, CA 95501-0134
Phone
(707) 441-1900
NPI assigned
Feb 29, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 75990 CA Primary

Addresses

Primary practice location

1424 Broadway
Eureka, CA 95501-0134

Mailing address

2310 Dogwood Rd
McKinleyville, CA 95519-4019
Phone (843) 283-8031

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
75990CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co PastSince Apr 21, 2024 Accepting new patients
Walgreen Co PastSince Apr 21, 2024 Accepting new patients
Longs Drug Store California LLC PastSince Mar 1, 2024 Accepting new patients
Longs Drug Stores California LLC PastSince Mar 1, 2024 Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1982461679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 DOGWOOD RD",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955194019",
            "telephone_number": "843-283-8031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 BROADWAY",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955010134",
            "telephone_number": "707-441-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIANA-BALTZER",
        "first_name": "NICOLAS",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "75990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; 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.