Active NPI
Gary M Blackmon, R.PH.
- Pharmacist
- Port St Lucie, FL
National Provider Identifier
1053591057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS0020470
- Practice address
- 1025 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5386 - Phone
- (772) 335-4200
- NPI assigned
- Nov 7, 2007
- 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 | PS0020470 | FL | Primary |
Addresses
Primary practice location
1025 SE Port St Lucie Blvd
Port St Lucie, FL 34952-5386
Mailing address
961 SE Thornhill Dr
Port St Lucie, FL 34983-4057
Phone (772) 879-4186
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 |
|---|---|---|---|
| PS0020470 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194393600000",
"number": "1053591057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "961 SE THORNHILL DR",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349834057",
"telephone_number": "772-879-4186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 SE PORT ST LUCIE BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349525386",
"telephone_number": "772-335-4200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKMON",
"first_name": "GARY",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-07",
"last_updated": "2007-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS0020470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.