Active NPI
Nicholas Petty, PHARMD
- Pharmacist
- North Port, FL
National Provider Identifier
1003403775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS58943
- Practice address
- 15180 Tamiami TRL
North Port, FL 34287-2742 - Phone
- (941) 423-6700
- NPI assigned
- Dec 28, 2020
- 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 | PS58943 | FL | Primary |
Addresses
Primary practice location
15180 Tamiami TRL
North Port, FL 34287-2742
Mailing address
5081 Winter Rose Way
Venice, FL 34293-8213
Phone (970) 685-0407
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS58943 | Other | FL | PHARMACIST LICENSE |
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 |
|---|---|---|---|
| PS58943 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609113600000",
"number": "1003403775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5081 WINTER ROSE WAY",
"city": "VENICE",
"state": "FL",
"postal_code": "342938213",
"telephone_number": "970-685-0407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15180 TAMIAMI TRL",
"city": "NORTH PORT",
"state": "FL",
"postal_code": "342872742",
"telephone_number": "941-423-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "NICHOLAS",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-28",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS58943",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE",
"identifier": "PS58943",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Port, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.