Active NPI
Mark Bertram Dodge, BS PHARM
- Pharmacist
- Palm Harbor, FL
National Provider Identifier
1114368644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS19102
- Practice address
- 975 Tampa Rd
Palm Harbor, FL 34683-5529 - Phone
- (727) 772-8119
- NPI assigned
- Jul 12, 2013
- Last updated
- Jul 12, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 | PS19102 | FL | Primary |
Addresses
Primary practice location
975 Tampa Rd
Palm Harbor, FL 34683-5529
Mailing address
197 Mayfair Cir W
Palm Harbor, FL 34683-5821
Phone (727) 784-1345
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
- Bachelor of Science, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS19102 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holiday CVS LLC | Past | Accepting new patients | |
| Holiday CVS L.L.C. | Past | Accepting new patients |
Organizations & group practices 2
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": "1373587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373587200000",
"number": "1114368644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "197 MAYFAIR CIR W",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346835821",
"telephone_number": "727-784-1345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "975 TAMPA RD",
"city": "PALM HARBOR",
"state": "FL",
"postal_code": "346835529",
"telephone_number": "727-772-8119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODGE",
"first_name": "MARK",
"middle_name": "BERTRAM",
"name_prefix": "Mr.",
"credential": "BS PHARM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-12",
"last_updated": "2013-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS19102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Harbor, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.