Active NPI
Anderson Ebai Kajang, PHARM.D.
- Pharmacist
- Fort Walton Beach, FL
National Provider Identifier
1487250908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS60176
- Practice address
- 825 Beal Pkwy NW
Fort Walton Beach, FL 32547-1955 - Phone
- (850) 314-0851
- NPI assigned
- Dec 9, 2020
- Sex
- Male
- Sole proprietor
- No
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 | PS60176 | FL | Primary |
Addresses
Primary practice location
825 Beal Pkwy NW
Fort Walton Beach, FL 32547-1955
Mailing address
825 Beal Pkwy NW
Fort Walton Beach, FL 32547-1955
Phone (850) 314-0851
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | InterCom | Health Information Exchange (HIE) |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS60176 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pharmacy
- Fort Walton Beach, FL
- NPI 1700891967
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607472000000",
"number": "1487250908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "825 BEAL PKWY NW",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325471955",
"telephone_number": "850-314-0851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 BEAL PKWY NW",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325471955",
"telephone_number": "850-314-0851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAJANG",
"first_name": "ANDERSON",
"middle_name": "EBAI",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-09",
"last_updated": "2020-12-09",
"certification_date": "2020-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS60176",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "InterCom",
"affiliation": "N",
"endpointDescription": "Communicates with patients and healthcare providers",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "StoreNet",
"address_1": "825 Beal Pkwy NW",
"city": "Fort Walton Beach",
"state": "FL",
"country_code": "US",
"postal_code": "325471955",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.