Active NPI
Andrew San Agustin, PHARMD
- Pharmacist
- Orlando, FL
National Provider Identifier
1508469222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS57283
- Practice address
- 11619 Daryl Carter Pkwy
Orlando, FL 32821-4000 - Phone
- (407) 550-9716
- Fax
- (407) 641-4325
- NPI assigned
- Nov 17, 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 | PS57283 | FL | Primary |
Addresses
Primary practice location
11619 Daryl Carter Pkwy
Orlando, FL 32821-4000
Mailing address
11619 Daryl Carter Pkwy
Orlando, FL 32821-4000
Phone (407) 550-9716
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS57283 | Other | FL | FLORIDA BOARD OF 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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS57283 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1508469222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11619 DARYL CARTER PKWY",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328214000",
"telephone_number": "407-550-9716",
"fax_number": "407-641-4325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11619 DARYL CARTER PKWY",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328214000",
"telephone_number": "407-550-9716",
"fax_number": "407-641-4325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAN AGUSTIN",
"first_name": "ANDREW",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-17",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS57283",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA BOARD OF PHARMACY",
"identifier": "PS57283",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.