Active NPI
Jeffrey Boudette, RPH
- Pharmacist
- Live Oak, FL
National Provider Identifier
1083032353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS37931
- Practice address
- 1515 Ohio Ave S
Live Oak, FL 32064-4513 - Phone
- (386) 330-2766
- NPI assigned
- Apr 2, 2014
- Last updated
- Jun 5, 2025
- 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 | PS37931 | FL | Primary |
Addresses
Primary practice location
1515 Ohio Ave S
Live Oak, FL 32064-4513
Mailing address
1515 Ohio Ave S
Live Oak, FL 32064-4513
Phone (386) 330-2766
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 |
|---|---|---|---|
| PS37931 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Holiday CVS LLC | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Holiday CVS L.L.C. | Past | Accepting new patients |
Locations
1515 Ohio Ave S
Live Oak, FL 32064
Phone (386) 330-2766
Organizations & group practices 5
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1396396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749081600000",
"number": "1083032353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 OHIO AVE S",
"city": "LIVE OAK",
"state": "FL",
"postal_code": "320644513",
"telephone_number": "386-330-2766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 OHIO AVE S",
"city": "LIVE OAK",
"state": "FL",
"postal_code": "320644513",
"telephone_number": "386-330-2766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUDETTE",
"first_name": "JEFFREY",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-04-02",
"last_updated": "2025-06-05",
"certification_date": "2025-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS37931",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Live Oak, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.