Active NPI
John Adam Pross, PHG
- Pharmacist
- Syracuse, NE
National Provider Identifier
1366575219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26350
- Practice address
- 106 Arterial Rd
Syracuse, NE 13206 - Phone
- (315) 437-0699
- Fax
- (315) 433-9091
- NPI assigned
- Mar 13, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 26350 | NY | Primary |
Addresses
Primary practice location
106 Arterial Rd
Syracuse, NE 13206
Mailing address
3131 Hidden Lake Dr
Baldwinsville, NY 13027-1529
Phone (315) 635-0919
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 |
|---|---|---|---|
| 26350 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henderson's Drug Store, Inc. | Past | Accepting new patients | |
| Henderson's Drug Store, Inc. | 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": "1173744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366575219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3131 HIDDEN LAKE DR",
"city": "BALDWINSVILLE",
"state": "NY",
"postal_code": "130271529",
"telephone_number": "315-635-0919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 ARTERIAL RD",
"city": "SYRACUSE",
"state": "NE",
"postal_code": "13206",
"telephone_number": "315-437-0699",
"fax_number": "315-433-9091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROSS",
"first_name": "JOHN",
"middle_name": "ADAM",
"credential": "PHG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "26350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.