NPIMap

Diego Gomez, PHARMD

Individual provider Active NPI Pharmacist · Jacksonville, FL

NPI 1356941348 · NPPES record last updated Nov 11, 2020

Key facts

NPI
1356941348
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
PS49289 (FL)
Practice address
11757 Beach Blvd Ste 7
Jacksonville, FL 32246-6633
Phone
(904) 531-4556
Fax
(904) 376-7718
NPI assigned
Oct 28, 2020
Sex
Male
Sole proprietor
Yes

Organizations & group practices 3

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
PS49289FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Kumu Health Inc. Current
since Apr 10, 2022		 Accepting new patients
Public Square Pharmacy LLC Current
since Nov 1, 2020		 Accepting new patients
Public Square Pharmacy LLC Current Accepting new patients

Locations

11757 Beach Blvd
Ste 7
Jacksonville, FL 32246
Phone (904) 531-4556

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS49289 FL Yes

Addresses

Primary practice location

11757 Beach Blvd Ste 7
Jacksonville, FL 32246-6633

Mailing address

7836 Timberlin Park Blvd
Jacksonville, FL 32256-5413
Phone (941) 204-1610

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 11, 2020.

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1356941348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7836 TIMBERLIN PARK BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565413",
            "telephone_number": "941-204-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11757 BEACH BLVD STE 7",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322466633",
            "telephone_number": "904-531-4556",
            "fax_number": "904-376-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "DIEGO",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS49289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

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Sources for this page

Verify at the official NPI Registry.