Susan Dubose

Primary specialty

PharmacyTaxonomy code 333600000X

License

EH11591 Issued in FL

Legal business name

SUSAN DUBOSE

Practice address

1436 S 6TH St
Macclenny, FL 32063-4623

Phone

(904) 259-5868

Fax

(904) 259-5275

NPI assigned

Aug 14, 2011

Last updated

Aug 14, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

WINN DIXIE 0144As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Lonna Wilkes, PHARMD

Title

Pharmacist

Phone

(904) 259-5868

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Heidi Joan Vassallo, CPHT

  • Pharmacy Technician
  • Macclenny, FL
  • NPI 1154422145
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313280000000",
    "number": "1366721904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 S 6TH ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320634623",
            "telephone_number": "904-259-5868",
            "fax_number": "904-259-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 S 6TH ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320634623",
            "telephone_number": "904-259-5868",
            "fax_number": "904-259-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN DUBOSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINN DIXIE 0144",
        "enumeration_date": "2011-08-14",
        "last_updated": "2011-08-14",
        "status": "A",
        "authorized_official_last_name": "WILKES",
        "authorized_official_first_name": "LONNA",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "904-259-5868",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "EH11591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101160000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Medical Clinic PA
• Sovereign Healthcare of Macclenny, LLC (MacClenny Nursing & Rehab Center)
• Phillip Wayne Steen, DDS
• Niesha Stevens, PTA
• Elyshia Stoutamire
• Tailored Healthcare Inc
• Tammy E Taylor, M.ED, LMHC
• Whitney Ruth Taylor, RDH
• Tecson Family Practice Inc
• The Clair Winston House,LLC

• Pharmacy in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 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.

Verify at the official NPI Registry.