Bernard Mballesube, PHARM.D

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PS40873 Issued in FL

Practice address

5151 Belle Terre Pkwy
Palm Coast, FL 32137-8689

Phone

(386) 446-9449

Fax

(386) 446-9971

NPI assigned

Jan 13, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Holiday CVS L.L.C.

  • Pharmacy
  • Wesley Chapel, FL
  • NPI 1770467466
  NPD (past)
• Holiday CVS LLC

  • Pharmacy
  • Palm Coast, FL
  • NPI 1477657450
  NPD (past)

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1386233476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5151 BELLE TERRE PKWY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378689",
            "telephone_number": "386-446-9449",
            "fax_number": "386-446-9971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 BELLE TERRE PKWY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378689",
            "telephone_number": "386-446-9449",
            "fax_number": "386-446-9971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBALLESUBE",
        "first_name": "BERNARD",
        "credential": "PHARM.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PS40873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Matthews, PTA
• Donna M Mauz
• Lily Mayorga
• Alison Mazzatelli, DPT
• Dianne Lynne Mazzo, ARNP
• Ladana Shareice Mboup
• Aynne McAvoy
• Kim McCandless
• John P. McCarthy, M.D.
• Malik McCarthy

• Community/Retail Pharmacy in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; 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.