Active NPI
Terry D Mundorff Sr., RPH
- Pharmacist
- Middleburg, FL
National Provider Identifier
1275879900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS21408
- Practice address
- 2720 Blanding Blvd
Winn Dixie Pharmacy
Middleburg, FL 32068-5648 - Phone
- (904) 282-3070
- NPI assigned
- Dec 28, 2012
- Last updated
- Dec 28, 2012
- 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 | PS21408 | FL | Primary |
Addresses
Primary practice location
2720 Blanding Blvd
Winn Dixie Pharmacy
Middleburg, FL 32068-5648
Mailing address
497 SW 3Rd St
Melrose, FL 32666
Phone (352) 475-1729
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 |
|---|---|---|---|
| PS21408 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356652800000",
"number": "1275879900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "497 SW 3RD ST",
"city": "MELROSE",
"state": "FL",
"postal_code": "32666",
"telephone_number": "352-475-1729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 BLANDING BLVD",
"address_2": "WINN DIXIE PHARMACY",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320685648",
"telephone_number": "904-282-3070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUNDORFF",
"first_name": "TERRY",
"middle_name": "D",
"name_suffix": "Sr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-12-28",
"last_updated": "2012-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS21408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.