NPIMap

Individual provider Active NPI

Mandy Yates, PHARMD, RPH

  • Pharmacist
  • Saint Johns, FL
National Provider Identifier
1124622329
Registry record updated Nov 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS47877 Issued in FL
Practice address
2680 Race Track Rd
Saint Johns, FL 32259-6278
Phone
(904) 230-6718
Fax
(904) 230-6725
NPI assigned
Nov 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS47877 FL Primary

Addresses

Primary practice location

2680 Race Track Rd
Saint Johns, FL 32259-6278

Mailing address

2680 Race Track Rd
Saint Johns, FL 32259-6278
Phone (904) 230-6718

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
Doctor of Pharmacy, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PS47877FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Holiday CVS LLC PastSince Dec 6, 2020 Accepting new patients
Holiday CVS L.L.C. PastSince Dec 6, 2020 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1606521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606521600000",
    "number": "1124622329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 RACE TRACK RD",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596278",
            "telephone_number": "904-230-6718",
            "fax_number": "904-230-6725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 RACE TRACK RD",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596278",
            "telephone_number": "904-230-6718",
            "fax_number": "904-230-6725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YATES",
        "first_name": "MANDY",
        "credential": "PHARMD, RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-28",
        "last_updated": "2020-11-28",
        "certification_date": "2020-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS47877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Johns, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2020; 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.