NPIMap

Organization Active NPI

Outreach Community Care Network Inc

  • Community/Retail Pharmacy
  • Daytona Beach, FL
National Provider Identifier
1043776057
Registry record updated Feb 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
OUTREACH COMMUNITY CARE NETWORK INC
Practice address
240 N. Frederick Avenue
Daytona Beach, FL 32114
Phone
(386) 675-0118
Fax
(386) 257-1245
NPI assigned
Feb 14, 2019
Organization subpart
Yes
Parent organization
OUTREACH COMMUNITY CARE NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 14, 2019

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

Authorized official

Name
Dr. Chester Wilson Jr.
Title
Executive Director
Phone
(386) 675-0098

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

240 N. Frederick Avenue
Daytona Beach, FL 32114

Mailing address

240 N. Frederick Avenue
Daytona Beach, FL 32114
Phone (386) 675-0118

National Provider Directory

National Provider Directory
Part of
Outreach Community Care Network

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550102400000",
    "number": "1043776057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 N. FREDERICK AVENUE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-675-0118",
            "fax_number": "386-257-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 N. FREDERICK AVENUE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-675-0118",
            "fax_number": "386-257-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH COMMUNITY CARE NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUTREACH COMMUNITY CARE NETWORK",
        "enumeration_date": "2019-02-14",
        "last_updated": "2019-02-14",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CHESTER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "386-675-0098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; 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.