Active NPI
Tremayne Wade
- Pharmacist
- Deland, FL
National Provider Identifier
1578332136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS36814
- Practice address
- 300 E New York Ave
Deland, FL 32724-5532 - Phone
- (386) 943-4011
- NPI assigned
- Dec 25, 2023
- 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 | PS36814 | FL | Primary |
Addresses
Primary practice location
300 E New York Ave
Deland, FL 32724-5532
Mailing address
301 Ivy Lakes Dr
Saint Johns, FL 32259-7947
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 |
|---|---|---|---|
| PS36814 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
300 E New York Ave
Deland, FL 32724
Phone (386) 943-4011
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 and National Provider Directory roles.
-
- Pharmacy
- Deland, FL
- NPI 1093977084
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- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703462400000",
"number": "1578332136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 IVY LAKES DR",
"city": "SAINT JOHNS",
"state": "FL",
"postal_code": "322597947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 E NEW YORK AVE",
"city": "DELAND",
"state": "FL",
"postal_code": "327245532",
"telephone_number": "386-943-4011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "TREMAYNE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-12-25",
"last_updated": "2023-12-25",
"certification_date": "2023-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS36814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.