Active NPI
Amy Phan
- Pharmacist
- Green Cove Springs, FL
National Provider Identifier
1356622559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS42207
- Practice address
- 103 S Orange Ave
Green Cove Springs, FL 32043-4127 - Phone
- (904) 529-9156
- Fax
- (904) 529-9108
- NPI assigned
- Aug 31, 2011
- 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 | PS42207 | FL | Primary |
Addresses
Primary practice location
103 S Orange Ave
Green Cove Springs, FL 32043-4127
Mailing address
103 S Orange Ave
Green Cove Springs, FL 32043-4127
Phone (904) 529-9156
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 |
|---|---|---|---|
| PS42207 | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314748800000",
"number": "1356622559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 S ORANGE AVE",
"city": "GREEN COVE SPRINGS",
"state": "FL",
"postal_code": "320434127",
"telephone_number": "904-529-9156",
"fax_number": "904-529-9108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 S ORANGE AVE",
"city": "GREEN COVE SPRINGS",
"state": "FL",
"postal_code": "320434127",
"telephone_number": "904-529-9156",
"fax_number": "904-529-9108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "AMY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-31",
"last_updated": "2011-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS42207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Cove Springs, FL
- Karen Patterson
- Estrella Jane A. Pena, PT
- Ashley F Perez
- Ryan Ciro Perretti
- Gina Perrone, ACA, BC-HIS
- Pinnacle Wellness Healthcare Services
- George Edward Platt, M.D.
- Preferred Touch Healthcare Services LLC
- Providian Functional Capacity Specialists (Providian Physical Therapy and Functional Capacity Specialists)
- Ruth Esther Pruitt, RMHI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.