Active NPI
Harryanne Etienne
- Pharmacist
- Port St Lucie, FL
National Provider Identifier
1285221226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS61415
- Practice address
- 2873 SW Port St Lucie Blvd
Port St Lucie, FL 34953-2884 - Phone
- (772) 344-1657
- NPI assigned
- Dec 23, 2020
- 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 | PS61415 | FL | Primary |
Addresses
Primary practice location
2873 SW Port St Lucie Blvd
Port St Lucie, FL 34953-2884
Mailing address
2873 SW Port St Lucie Blvd
Port St Lucie, FL 34953-2884
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS61415 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holiday CVS LLC | Past | Accepting new patients | |
| Holiday CVS L.L.C. | 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": "1608681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608681600000",
"number": "1285221226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2873 SW PORT ST LUCIE BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349532884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2873 SW PORT ST LUCIE BLVD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349532884",
"telephone_number": "772-344-1657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETIENNE",
"first_name": "HARRYANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-23",
"last_updated": "2020-12-23",
"certification_date": "2020-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS61415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.