Active NPI
Pacifico National Inc
- Compounding Pharmacy
- Melbourne, FL
National Provider Identifier
1366416448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Compounding Pharmacy
- Legal business name
- PACIFICO NATIONAL INC
- Practice address
- 1515 Elizabeth St
Ste J
Melbourne, FL 32901-3000 - Phone
- (321) 872-0723
- Fax
- (321) 872-0721
- NPI assigned
- Feb 15, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark Sangree
- Title
- Pres
- Phone
- (321) 872-0723
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Compounding Pharmacy | 3336C0004X | 16452MS | ID | |
| Compounding Pharmacy | 3336C0004X | 5301008923 | MI | |
| Compounding Pharmacy | 3336C0004X | PH27532 | FL | |
| Compounding Pharmacy | 3336C0004X | FL1446 | KY | |
| Compounding Pharmacy | 3336C0004X | NRX1701137 | DC | |
| Compounding Pharmacy | 3336C0004X | A9-0001042 | DE | |
| Compounding Pharmacy | 3336C0004X | 3942 | IA | |
| Compounding Pharmacy | 3336C0004X | P03052 | MD | |
| Compounding Pharmacy | 3336C0004X | 64000903A | IN | |
| Compounding Pharmacy | 3336C0004X | 22-02899 | KS | |
| Compounding Pharmacy | 3336C0004X | PHNR 000556 | GA | |
| Compounding Pharmacy | 3336C0004X | 006292 | LA | |
| Compounding Pharmacy | 3336C0004X | 054.016601 | IL | |
| Compounding Pharmacy | 3336C0004X | PMP-1330 | HI | |
| Compounding Pharmacy | 3336C0004X | AL | Primary |
Addresses
Primary practice location
1515 Elizabeth St
Ste J
Melbourne, FL 32901-3000
Mailing address
1515 Elizabeth St
Ste J
Melbourne, FL 32901-3000
Phone (321) 872-0723
Other identifiers 20
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366416448 | Medicaid | MN | |
| 1366416448 | Medicaid | IL | |
| 226807 | Medicaid | NH | |
| 546330 | Medicaid | NJ | |
| 1000055714 | Medicaid | WI | |
| 1366416448 | Medicaid | ID | |
| 1366416448 | Medicaid | UT | |
| 2856995 | Medicaid | OH | |
| 02199910 | Medicaid | FL | |
| 134038 | Medicaid | AZ | |
| 2013120 | Other | PK | |
| 201352590A | Medicaid | IN | |
| 7100410000 | Medicaid | KY | |
| 10026562600 | Medicaid | NE | |
| 1028490 | Medicaid | VT | |
| 105780400 | Medicaid | MD | |
| 200647710A | Medicaid | OK | |
| 1366416448 | Medicaid | NM | |
| 2059467 | Medicaid | WA | |
| 500707688 | Medicaid | OR |
Other names 1
- AMEX PHARMACY
National Provider Directory
National Provider DirectoryLocations
1515 Elizabeth St
Ste J
Melbourne, FL 32901
Phone (321) 872-0723
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Melbourne, FL
- NPI 1073058954
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1492646400000",
"number": "1366416448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 ELIZABETH ST",
"address_2": "STE J",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329013000",
"telephone_number": "321-872-0723",
"fax_number": "321-872-0721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 ELIZABETH ST",
"address_2": "STE J",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329013000",
"telephone_number": "321-872-0723",
"fax_number": "321-872-0721"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PACIFICO NATIONAL INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-02-15",
"last_updated": "2017-04-20",
"status": "A",
"authorized_official_last_name": "SANGREE",
"authorized_official_first_name": "MARK",
"authorized_official_title_or_position": "PRES",
"authorized_official_telephone_number": "321-872-0723"
},
"taxonomies": [
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "ID",
"license": "16452MS",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "MI",
"license": "5301008923",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "FL",
"license": "PH27532",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "KY",
"license": "FL1446",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "DC",
"license": "NRX1701137",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "DE",
"license": "A9-0001042",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "IA",
"license": "3942",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "MD",
"license": "P03052",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "IN",
"license": "64000903A",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "KS",
"license": "22-02899",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "GA",
"license": "PHNR 000556",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "LA",
"license": "006292",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "IL",
"license": "054.016601",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "HI",
"license": "PMP-1330",
"primary": false
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": "AL",
"license": null,
"primary": true
}
],
"identifiers": [
{
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{
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},
{
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"identifier": "1000055714",
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},
{
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},
{
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"state": "UT"
},
{
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"issuer": null,
"identifier": "2856995",
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},
{
"code": "05",
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"issuer": null,
"identifier": "02199910",
"state": "FL"
},
{
"code": "05",
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"issuer": null,
"identifier": "134038",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2013120",
"state": null
},
{
"code": "05",
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"identifier": "201352590A",
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},
{
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"identifier": "10026562600",
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"identifier": "1028490",
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},
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"identifier": "105780400",
"state": "MD"
},
{
"code": "05",
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"issuer": null,
"identifier": "200647710A",
"state": "OK"
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{
"code": "05",
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"issuer": null,
"identifier": "1366416448",
"state": "NM"
},
{
"code": "05",
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"issuer": null,
"identifier": "2059467",
"state": "WA"
},
{
"code": "05",
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"issuer": null,
"identifier": "500707688",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "AMEX PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.