Active NPI
Mark Chiedo, RPH
- Pharmacist
- Jacksonville, FL
National Provider Identifier
1265466650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS31130
- Practice address
- 7790 Blanding Blvd
Jacksonville, FL 32244-5114 - Phone
- (904) 771-0571
- NPI assigned
- Jul 10, 2006
- 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 | PS31130 | FL | Primary |
Addresses
Primary practice location
7790 Blanding Blvd
Jacksonville, FL 32244-5114
Mailing address
10640 Brighton Hill Cir N
Jacksonville, FL 32256-4536
Phone (904) 757-1289
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS31130 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holiday CVS L.L.C. | Past | Accepting new patients | |
| Holiday CVS LLC | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1265466650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10640 BRIGHTON HILL CIR N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322564536",
"telephone_number": "904-757-1289",
"fax_number": "904-757-6753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7790 BLANDING BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322445114",
"telephone_number": "904-771-0571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHIEDO",
"first_name": "MARK",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS31130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.