Active NPI
Nicketris Simmons Mandela, PHARMD
- Pharmacist
- Hialeah, FL
National Provider Identifier
1144662362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS50810
- Practice address
- 5701 NW 183Rd St
Hialeah, FL 33015-6022 - Phone
- (305) 625-0952
- Fax
- (305) 623-7742
- NPI assigned
- Jul 30, 2013
- Last updated
- Jan 3, 2014
- 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 | PS50810 | FL | Primary |
Addresses
Primary practice location
5701 NW 183Rd St
Hialeah, FL 33015-6022
Mailing address
13480 NW 4TH St Apt 105
Pembroke Pines, FL 33028-2240
Phone (954) 235-2477
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS50810 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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": "1375142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388707200000",
"number": "1144662362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13480 NW 4TH ST APT 105",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330282240",
"telephone_number": "954-235-2477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5701 NW 183RD ST",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330156022",
"telephone_number": "305-625-0952",
"fax_number": "305-623-7742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDELA",
"first_name": "NICKETRIS",
"middle_name": "SIMMONS",
"name_prefix": "Mrs.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-30",
"last_updated": "2014-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS50810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.