Individual provider Active NPI

Iraisy Paneque, PHARMD

  • Pharmacist
  • Dade City, FL
National Provider Identifier
1225569247
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS37965 Issued in FL
Practice address
12620 US Highway 301
Dade City, FL 33525-6058
Phone
(352) 521-0155
NPI assigned
Mar 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS37965 FL Primary

Addresses

Primary practice location

12620 US Highway 301
Dade City, FL 33525-6058

Mailing address

12620 US Highway 301
Dade City, FL 33525-6058

Other identifiers 1

IdentifierTypeStateIssuer
PS37965OtherFLDEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE

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

LicenseStateTypeSpecialty
PS37965FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
MMRX Healthsolutions Inc Past Accepting new patients

Organizations & group practices 1

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": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490140800000",
    "number": "1225569247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12620 US HIGHWAY 301",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335256058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12620 US HIGHWAY 301",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335256058",
            "telephone_number": "352-521-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANEQUE",
        "first_name": "IRAISY",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-22",
        "last_updated": "2017-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS37965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE",
            "identifier": "PS37965",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dade City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; 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.