Active NPI
Pebblebrook Inc
- Community/Retail Pharmacy
- Naples, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PH30941
- Legal business name
- PEBBLEBROOK INC
- Practice address
- 4861 Golden Gate Pkwy
Naples, FL 34116-6953 - Phone
- (239) 331-3836
- Fax
- (239) 692-8213
- NPI assigned
- Aug 31, 2017
- 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
- Mr. Suresh Chaudhari, RPH
- Title
- Authorized Person
- Phone
- (239) 331-3836
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PH30941 | FL | Primary |
Addresses
Primary practice location
4861 Golden Gate Pkwy
Naples, FL 34116-6953
Mailing address
15215 Collier Blvd Ste 308
Naples, FL 34119-6835
Phone (239) 331-3836
Other names 1
- COLLIER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210115000770 | FL | Part B Supplier - Mass Immunization (Roster Biller Only) | 0042623886 |
1 other NPI on this enrollment Practice locations: Naples, FL |
| O20210129002070 | FL | Part B Supplier - Pharmacy | 0042623886 |
1 other NPI on this enrollment Practice locations: Naples, FL |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community/Retail Pharmacy
- Naples, FL
- NPI 1063856367
O20210115000770, O20210129002070
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2208596 | Collier Pharmacy | Certificate of waiver | Jan 6, 2027 |
National Provider Directory
National Provider DirectoryLocations
4861 Golden Gate Pkwy
Naples, FL 34116
Phone (239) 331-3836
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Naples, FL
- NPI 1790009819
-
- Pharmacist
- Naples, FL
- NPI 1134711260
-
- Pharmacist
- Naples, FL
- NPI 1124784350
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504137600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1622851200000",
"number": "1396263299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15215 COLLIER BLVD STE 308",
"city": "NAPLES",
"state": "FL",
"postal_code": "341196835",
"telephone_number": "239-331-3836",
"fax_number": "239-692-8213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4861 GOLDEN GATE PKWY",
"city": "NAPLES",
"state": "FL",
"postal_code": "341166953",
"telephone_number": "239-331-3836",
"fax_number": "239-692-8213"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEBBLEBROOK INC",
"organizational_subpart": "NO",
"enumeration_date": "2017-08-31",
"last_updated": "2021-06-05",
"certification_date": "2021-06-05",
"status": "A",
"authorized_official_last_name": "CHAUDHARI",
"authorized_official_first_name": "SURESH",
"authorized_official_title_or_position": "AUTHORIZED PERSON",
"authorized_official_telephone_number": "239-331-3836",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "FL",
"license": "PH30941",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "COLLIER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Naples, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.