Active NPI
Jacqueline Naomi Nicolas, RPH
- Pharmacist
- Lake Worth, FL
National Provider Identifier
1538442702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 38430
- Practice address
- 4530 Lantana Rd
Lake Worth, FL 33463-6908 - Phone
- (561) 963-2588
- Fax
- (561) 963-4345
- NPI assigned
- Sep 23, 2011
- Last updated
- Sep 23, 2011
- 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 | 38430 | FL | Primary |
Addresses
Primary practice location
4530 Lantana Rd
Lake Worth, FL 33463-6908
Mailing address
4530 Lantana Rd
Lake Worth, FL 33463-6908
Phone (561) 963-2588
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 |
|---|---|---|---|
| 38430 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
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, 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": "1316736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316736000000",
"number": "1538442702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4530 LANTANA RD",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334636908",
"telephone_number": "561-963-2588",
"fax_number": "561-963-4345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4530 LANTANA RD",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334636908",
"telephone_number": "561-963-2588",
"fax_number": "561-963-4345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLAS",
"first_name": "JACQUELINE",
"middle_name": "NAOMI",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-23",
"last_updated": "2011-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "38430",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.