NPIMap

Individual provider Active NPI

Adenike Christiana Gansallo, PHARMACIST

  • Pharmacist
  • Lutz, FL
National Provider Identifier
1114080652
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS29870 Issued in FL
Practice address
4102 Heritage Lake CT
Lutz, FL 33558
Phone
(813) 784-7563
Fax
(813) 949-6609
NPI assigned
Dec 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS29870 FL Primary

Addresses

Primary practice location

4102 Heritage Lake CT
Lutz, FL 33558

Mailing address

4102 Heritage Lake CT
Lutz, FL 33558
Phone (813) 784-7563

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

LicenseStateTypeSpecialty
PS29870FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Grande Pharmacy LLC Current Accepting new patients
Capricorn Healthcare Services LLC Current Accepting new patients
Capricorn Healthcare Services LLC Current Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1114080652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4102 HERITAGE LAKE CT",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "33558",
            "telephone_number": "813-784-7563",
            "fax_number": "813-949-6609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 HERITAGE LAKE CT",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "33558",
            "telephone_number": "813-784-7563",
            "fax_number": "813-949-6609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANSALLO",
        "first_name": "ADENIKE",
        "middle_name": "CHRISTIANA",
        "credential": "PHARMACIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS29870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.