Tristan Patrice Seagrove, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

E-010410 Issued in MS

Practice address

2150 Iowa Blvd
Vicksburg, MS 39180-5572

Phone

(601) 639-9202

Fax

(601) 638-9207

NPI assigned

Oct 27, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Tristan Seagrove Dugger Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1003416348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 LAKE CAVALIER RD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107151",
            "telephone_number": "601-942-3167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 IOWA BLVD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805572",
            "telephone_number": "601-639-9202",
            "fax_number": "601-638-9207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEAGROVE",
        "first_name": "TRISTAN",
        "middle_name": "PATRICE",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-010410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRISTAN",
            "last_name": "DUGGER",
            "middle_name": "SEAGROVE",
            "prefix": "DR.",
            "credential": "PHARMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pharmacist in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Pharmacist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.

Verify at the official NPI Registry.