Active NPI
Andrei Mino Olivares
- Pharmacist
- Frederick, MD
National Provider Identifier
1083395875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 29308
- Practice address
- 6970 Crestwood Blvd
Frederick, MD 21703-7239 - Phone
- (301) 682-9158
- NPI assigned
- Jul 26, 2023
- 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 | RP0013826 | WV | |
| Pharmacist | 183500000X | 29308 | MD | Primary |
Addresses
Primary practice location
6970 Crestwood Blvd
Frederick, MD 21703-7239
Mailing address
707 Tatum CT
Frederick, MD 21702-4936
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29308 | MD | MD | Pharmacist |
| RP0013826 | WV | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690934400000",
"number": "1083395875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 TATUM CT",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217024936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6970 CRESTWOOD BLVD",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217037239",
"telephone_number": "301-682-9158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINO OLIVARES",
"first_name": "ANDREI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-26",
"last_updated": "2023-08-02",
"certification_date": "2023-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WV",
"license": "RP0013826",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "29308",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.