Active NPI
Jessie Bush
- Pharmacist
- St Augustine, FL
National Provider Identifier
1346797735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS55434
- Practice address
- 2801 N Ponce de Leon Blvd
Saint Augustine, FL 32084-1648 - Phone
- (904) 810-2200
- NPI assigned
- Sep 2, 2016
- Last updated
- Dec 21, 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 | PS55434 | FL | Primary |
Addresses
Primary practice location
2801 N Ponce de Leon Blvd
Saint Augustine, FL 32084-1648
Mailing address
2801 N Ponce de Leon Blvd
Saint Augustine, FL 32084-1648
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 |
|---|---|---|---|
| PS55434 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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": "1472774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608508800000",
"number": "1346797735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 N PONCE DE LEON BLVD",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "320841648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 N PONCE DE LEON BLVD",
"city": "SAINT AUGUSTINE",
"state": "FL",
"postal_code": "320841648",
"telephone_number": "904-810-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "JESSIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-02",
"last_updated": "2020-12-21",
"certification_date": "2020-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS55434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.