Active NPI
Mary Anna Landolt
- Pharmacist
- San Diego, CA
National Provider Identifier
1588425979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 89125
- Practice address
- 602 Euclid Ave
San Diego, CA 92114-2207 - Phone
- (619) 321-1614
- NPI assigned
- Jan 22, 2024
- Last updated
- Jan 22, 2024
- Sex
- Female
- 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 | 89125 | CA | Primary |
Addresses
Primary practice location
602 Euclid Ave
San Diego, CA 92114-2207
Mailing address
5015 Cape May Ave Unit 207
San Diego, CA 92107-2570
Phone (314) 941-8748
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 |
|---|---|---|---|
| 89125 | CA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
602 Euclid Ave
San Diego, CA 92114
Phone (619) 321-1614
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, 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": "1705881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1588425979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5015 CAPE MAY AVE UNIT 207",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921072570",
"telephone_number": "314-941-8748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 EUCLID AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921142207",
"telephone_number": "619-321-1614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDOLT",
"first_name": "MARY",
"middle_name": "ANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-22",
"last_updated": "2024-01-22",
"certification_date": "2024-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "89125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.