Nicole Liedke, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS62319 Issued in FL

Practice address

4096 Mariner Bllvd
Spring Hill, FL 34609

Phone

(352) 200-5031

Fax

(352) 683-5318

NPI assigned

Nov 8, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1104581784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4096 MARINER BLVD",
            "city": "SPRING HILL",
            "state": "FL",
            "postal_code": "346092465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4096 MARINER BLLVD",
            "city": "SPRING HILL",
            "state": "FL",
            "postal_code": "34609",
            "telephone_number": "352-200-5031",
            "fax_number": "352-683-5318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEDKE",
        "first_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS62319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Rxm.12391@store.walgreens.com",
            "affiliation": "N",
            "address_1": "4096 Mariner Bllvd",
            "city": "Spring Hill",
            "state": "FL",
            "country_code": "US",
            "postal_code": "34609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pharmacist in Spring Hill, FL
• Providers in Spring Hill, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.