Active NPI
Douglas Wynn Staten, RPH
- Pharmacist
- Daytona Beach Shores, FL
National Provider Identifier
1487721890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH021909
- Practice address
- 3422 S Atlantic Ave
Daytona Beach Shores, FL 32118-6349 - Phone
- (386) 756-0481
- Fax
- (386) 756-0498
- NPI assigned
- Nov 29, 2006
- Last updated
- Nov 22, 2020
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E-08338 | MS | |
| Pharmacist | 183500000X | PS44814 | FL | |
| Pharmacist | 183500000X | RPH021909 | GA | Primary |
Addresses
Primary practice location
3422 S Atlantic Ave
Daytona Beach Shores, FL 32118-6349
Mailing address
1425 S Peninsula Dr
Daytona Beach, FL 32118-4829
Phone (404) 218-9704
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS44814 | FL | MD | Pharmacist |
| RPH021909 | GA | MD | Pharmacist |
| E-08338 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holiday CVS L.L.C. | Past | Accepting new patients | |
| Holiday CVS LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606003200000",
"number": "1487721890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1425 S PENINSULA DR",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321184829",
"telephone_number": "404-218-9704",
"fax_number": "386-236-9341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3422 S ATLANTIC AVE",
"city": "DAYTONA BEACH SHORES",
"state": "FL",
"postal_code": "321186349",
"telephone_number": "386-756-0481",
"fax_number": "386-756-0498"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATEN",
"first_name": "DOUGLAS",
"middle_name": "WYNN",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2020-11-22",
"certification_date": "2020-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-08338",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS44814",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH021909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Daytona Beach Shores, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.