Active NPI
Samuel Marcillon
- Pharmacist
- Jacksonville, FL
National Provider Identifier
1366155608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS65290
- Practice address
- 5999 Normandy Blvd
Jacksonville, FL 32205-6265 - Phone
- (904) 786-2148
- NPI assigned
- Jan 2, 2023
- Last updated
- Jan 7, 2023
- Sex
- Male
- 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 | PS65290 | FL | Primary |
Addresses
Primary practice location
5999 Normandy Blvd
Jacksonville, FL 32205-6265
Mailing address
10535 Lem Turner Rd Apt 211
Jacksonville, FL 32218-9102
Phone (772) 646-1838
Other practice location 1
10535 Lem Turner Rd Apt 211
Jacksonville, FL 32218-9102
Phone (772) 646-1838
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 |
|---|---|---|---|
| PS65290 | 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": "1672617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673049600000",
"number": "1366155608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10535 LEM TURNER RD APT 211",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322189102",
"telephone_number": "772-646-1838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5999 NORMANDY BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322056265",
"telephone_number": "904-786-2148"
}
],
"practiceLocations": [
{
"address_1": "10535 Lem Turner Rd Apt 211",
"address_purpose": "LOCATION",
"city": "Jacksonville",
"state": "FL",
"postal_code": "322189102",
"country_code": "US",
"telephone_number": "772-646-1838",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARCILLON",
"first_name": "SAMUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-02",
"last_updated": "2023-01-07",
"certification_date": "2023-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS65290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.