De2 LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH31227 Issued in FL

Legal business name

DE2 LLC

Doing business as

Panama Pharmacy #2
Panama Pharmacy at eMed

Practice address

6022 Atlantic Blvd
Jacksonville, FL 32211-7503

Phone

(904) 990-1054

Fax

(904) 990-1056

NPI assigned

Mar 6, 2018

Last updated

Nov 7, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Duane

Title

Managing Member

Phone

(904) 990-1054

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 2

• Panama Pharmacy #2 Doing business as
• Panama Pharmacy at eMed Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Paul Leonard, PHARMD

  • Pharmacist
  • Jacksonville, FL
  • NPI 1215377213
  NPD

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

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1467954438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7707 MERRILL RD UNIT 8664",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322397728",
            "telephone_number": "904-351-6434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6022 ATLANTIC BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322117503",
            "telephone_number": "904-990-1054",
            "fax_number": "904-990-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-06",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A",
        "authorized_official_last_name": "DUANE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "904-990-1054"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH31227",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025153200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176263",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panama Pharmacy #2",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Panama Pharmacy at eMed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie De Shano Wakeman, DPT
• Hernando De Soto, M.D.
• Bruno De Souza Ribeiro
• Katherine Ashley De Souza, DNP, APRN
• De Urgent Care Jax PA
• Nyla Deadwiler
• Latisha R Deal
• Angela Deallie
• Amber Nicole Dean, PA
• Anthony T Dean, DDS

• Community/Retail Pharmacy in Jacksonville, FL
• Providers in Jacksonville, 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 Nov 7, 2022; 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.

Verify at the official NPI Registry.