Active NPI
Larry William Pederson, R.PH., C.PH.
- Pharmacist
- Palatka, FL
National Provider Identifier
1023187101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS0015494
- Practice address
- 1302 River St
Palatka, FL 32177-5042 - Phone
- (386) 328-0558
- Fax
- (386) 328-9443
- NPI assigned
- Nov 6, 2006
- Last updated
- Mar 6, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS0015494 | FL | Primary |
| Pharmacist | 183500000X | PU0002781 | FL |
Addresses
Primary practice location
1302 River St
Palatka, FL 32177-5042
Mailing address
1302 River St
Palatka, FL 32177-5042
Phone (386) 328-0558
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
| License | State | Type | Specialty |
|---|---|---|---|
| PS0015494 | FL | MD | Pharmacist |
| PU0002781 | FL | MD | Pharmacist |
Organizations & group practices 8
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Aza Health
- Community/Retail Pharmacy
- Daytona Beach, FL
- NPI 1093211393
-
dba Aza Health
- Community/Retail Pharmacy
- Keystone Heights, FL
- NPI 1306928197
-
dba Aza Health
- Community/Retail Pharmacy
- Green Cove Springs, FL
- NPI 1518394477
-
dba Aza Health
- Community/Retail Pharmacy
- Hawthorne, FL
- NPI 1528204419
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488758400000",
"number": "1023187101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 RIVER ST",
"city": "PALATKA",
"state": "FL",
"postal_code": "321775042",
"telephone_number": "386-328-0558",
"fax_number": "386-328-9443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 RIVER ST",
"city": "PALATKA",
"state": "FL",
"postal_code": "321775042",
"telephone_number": "386-328-0558",
"fax_number": "386-328-9443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "LARRY",
"middle_name": "WILLIAM",
"credential": "R.PH., C.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-06",
"last_updated": "2017-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS0015494",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PU0002781",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palatka, FL
- Palatka Nursing and Rehab Op LLC (Radiant Nursing and Rehab at Palatka)
- Palatka Physical Therapy LLC
- Palatka SNF Operations LLC (Palatka Center for Rehabilitation and Healing)
- Kiesha Lashawn Parkinson, RN
- Patrick J Harris D O P a
- Mark Peluso, LCSW
- Robert Pendrak, MD
- Peopleone Health Florida, LLC
- Richard A. Perallon, DMD
- Maria Del Carmen Perez-Garcia, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.