Active NPI
Mary Ellen Berghauser, PHARMACIST
- Pharmacist
- Orange Park, FL
National Provider Identifier
1538202098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS31299
- Practice address
- 1339 Blanding Blvd
Orange Park, FL 32065-8022 - Phone
- (904) 272-2095
- Fax
- (904) 272-0310
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- 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 | PS31299 | FL | Primary |
Addresses
Primary practice location
1339 Blanding Blvd
Orange Park, FL 32065-8022
Mailing address
1575 Linkside Dr
Orange Park, FL 32003-7767
Phone (904) 264-8543
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS31299 | Other | FL | PHARMACY LICENSE |
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 |
|---|---|---|---|
| PS31299 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538202098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1575 LINKSIDE DR",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320037767",
"telephone_number": "904-264-8543",
"fax_number": "904-269-1283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1339 BLANDING BLVD",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320658022",
"telephone_number": "904-272-2095",
"fax_number": "904-272-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGHAUSER",
"first_name": "MARY",
"middle_name": "ELLEN",
"credential": "PHARMACIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS31299",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE",
"identifier": "PS31299",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.