Active NPI
Mandy Yates, PHARMD, RPH
- Pharmacist
- Saint Johns, FL
National Provider Identifier
1124622329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS47877
- Practice address
- 2680 Race Track Rd
Saint Johns, FL 32259-6278 - Phone
- (904) 230-6718
- Fax
- (904) 230-6725
- NPI assigned
- Nov 28, 2020
- Last updated
- Nov 28, 2020
- Sex
- Female
- Sole proprietor
- No
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 | 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
| License | State | Type | Specialty |
|---|---|---|---|
| PS47877 | 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": "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.