Active NPI
Theodore Elisme
- Pharmacist
- North Miami, FL
National Provider Identifier
1477195824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 59957
- Practice address
- 12130 NE Miami PL
North Miami, FL 33161-5359 - Phone
- (954) 296-4399
- NPI assigned
- Oct 16, 2019
- Last updated
- Oct 16, 2019
- 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 | 59957 | FL | Primary |
Addresses
Primary practice location
12130 NE Miami PL
North Miami, FL 33161-5359
Mailing address
12130 NE Miami PL
North Miami, FL 33161-5359
Phone (954) 296-4399
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 59957 | Medicaid | FL | |
| 59957 | Other | FL | PHARMACY |
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 |
|---|---|---|---|
| 59957 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571184000000",
"number": "1477195824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12130 NE MIAMI PL",
"city": "NORTH MIAMI",
"state": "FL",
"postal_code": "331615359",
"telephone_number": "954-296-4399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12130 NE MIAMI PL",
"city": "NORTH MIAMI",
"state": "FL",
"postal_code": "331615359",
"telephone_number": "954-296-4399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELISME",
"first_name": "THEODORE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-10-16",
"last_updated": "2019-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "59957",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "59957",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY",
"identifier": "59957",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Miami, FL
- Edye RBT Service LLC
- Leonard David Efrom, DDS PA
- Amira El Kholy, APRN
- Elevate Learning & Behavior LLC
- Elisabeth Seck Londono LLC
- Elite Holding Management Group,Inc. (Elite Transport)
- Elite Homecare Health Services
- Elite Nursing and Home Health Care
- Elite Resource and Staffing Agency Corp
- Elite Transport South, LLC (Elite Transport)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.