NPIMap

Organization Active NPI

A.G. Holley State Hospital

  • Institutional Pharmacy
  • Lantana, FL
National Provider Identifier
1295811032
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
PH0016562 Issued in FL
Legal business name
A.G. HOLLEY STATE HOSPITAL
Practice address
1199 Lantana Rd
Lantana, FL 33462-1514
Phone
(561) 540-3721
Fax
(561) 545-0372
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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

Authorized official

Name
Ms. Jerry Jean Stambaugh, RPH
Title
Pharmacist
Phone
(561) 540-3721

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X PH0016562 FL Primary

Addresses

Primary practice location

1199 Lantana Rd
Lantana, FL 33462-1514

Mailing address

1199 Lantana Rd
Lantana, FL 33462-1514
Phone (561) 540-3721

Other identifiers 1

IdentifierTypeStateIssuer
0215171-00MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Dept of Health Central Pharmacy185 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1199 W Lantana Rd
Lantana, FL 33462
Phone (321) 582-5666

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1295811032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1199 LANTANA RD",
            "city": "LANTANA",
            "state": "FL",
            "postal_code": "334621514",
            "telephone_number": "561-540-3721",
            "fax_number": "561-545-0372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 LANTANA RD",
            "city": "LANTANA",
            "state": "FL",
            "postal_code": "334621514",
            "telephone_number": "561-540-3721",
            "fax_number": "561-545-0372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A.G. HOLLEY STATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "STAMBAUGH",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "561-540-3721",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "FL",
            "license": "PH0016562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0215171-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lantana, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.