Individual provider Active NPI

Nick Sam Rougas, R.PH.

  • Pharmacist
  • Pueblo, CO
National Provider Identifier
1538436118
Registry record updated Nov 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PHA-8888 Issued in CO
Practice address
25140 E US Highway 50
Pueblo, CO 81006-9737
Phone
(719) 544-1371
Fax
(719) 546-1961
NPI assigned
Nov 25, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PHA-8888 CO Primary

Addresses

Primary practice location

25140 E US Highway 50
Pueblo, CO 81006-9737

Mailing address

25140 E US Highway 50
Pueblo, CO 81006-9737
Phone (719) 544-1371

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

LicenseStateTypeSpecialty
PHA-8888COMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Mesa Pharmacy of Pueblo, Inc. Pharmacist Current Accepting new patients

Locations

25140 E US Highway 50
Pueblo, CO 81006
Phone (719) 671-7683

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322179200000",
    "number": "1538436118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25140 E US HIGHWAY 50",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810069737",
            "telephone_number": "719-544-1371",
            "fax_number": "719-546-1961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25140 E US HIGHWAY 50",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810069737",
            "telephone_number": "719-544-1371",
            "fax_number": "719-546-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUGAS",
        "first_name": "NICK",
        "middle_name": "SAM",
        "credential": "R.PH.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-11-25",
        "last_updated": "2011-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "PHA-8888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.