Active NPI
Bryant Mutanga
- Pharmacist
- Tallahassee, FL
National Provider Identifier
1124893219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS64988
- Practice address
- 3831 N Monroe St
Tallahassee, FL 32303-2173 - Phone
- (850) 536-0417
- NPI assigned
- Nov 17, 2023
- Sex
- Male
- 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 | PS64988 | FL | Primary |
Addresses
Primary practice location
3831 N Monroe St
Tallahassee, FL 32303-2173
Mailing address
824 Eagle View Dr
Tallahassee, FL 32311-1204
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | securerecords.sanford.html |
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
| License | State | Type | Specialty |
|---|---|---|---|
| PS64988 | 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 and National Provider Directory roles.
-
- Pharmacy
- Wesley Chapel, FL
- NPI 1770467466
-
- Pharmacy
- Tallahassee, FL
- NPI 1649374596
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700179200000",
"number": "1124893219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "824 EAGLE VIEW DR",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323111204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3831 N MONROE ST",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323032173",
"telephone_number": "850-536-0417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTANGA",
"first_name": "BRYANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-17",
"last_updated": "2023-11-17",
"certification_date": "2023-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS64988",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "securerecords.sanford.html",
"affiliation": "N",
"address_1": "3831 N Monroe St",
"city": "Tallahassee",
"state": "FL",
"country_code": "US",
"postal_code": "323032173",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tallahassee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.