Jordan Bautista Gelacio

Primary specialty

PharmacistTaxonomy code 183500000X

License

90172 Issued in CA

Practice address

620 John Paul Jones Cir
Portsmouth, VA 23708-2111

Phone

(619) 947-3757

NPI assigned

Aug 20, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1194337055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 JOHN PAUL JONES CIR",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237082111",
            "telephone_number": "619-947-3757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GELACIO",
        "first_name": "JORDAN",
        "middle_name": "BAUTISTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-20",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "90172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rainey H Garrison, DMD
• Amy Kathleenn Gaspar
• Micah John Gaspary, M.D.
• Jerry Lee Gaut, DO
• Amy R Gavril, MD
• Tyler Hamilton Genaway, DO
• Richard Timothy Gendron, RPH
• Genesis Healthcare
• Ashley Parmarter Genthner, D.C.
• Stephen Michael Genthner, D.C.

• Pharmacist in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Pharmacist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.