Active NPI
Jerry Allen, PHARMD
- Pharmacist
- Port Orange, FL
National Provider Identifier
1619692803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS33345
- Practice address
- 1816 Dunlawton Ave
Port Orange, FL 32127-2921 - Phone
- (386) 322-3919
- NPI assigned
- Oct 10, 2022
- Sex
- Male
- 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 | PS33345 | FL | Primary |
Addresses
Primary practice location
1816 Dunlawton Ave
Port Orange, FL 32127-2921
Mailing address
429 Wisteria Rd
Daytona Beach, FL 32118-4939
Phone (386) 451-0700
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS33345 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Holiday CVS LLC | Past | Accepting new patients | |
| Holiday CVS L.L.C. | Past | Accepting new patients |
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
- Wesley Chapel, FL
- NPI 1770467466
-
- Pharmacy
- Port Orange, FL
- NPI 1366741258
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665360000000",
"number": "1619692803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "429 WISTERIA RD",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321184939",
"telephone_number": "386-451-0700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1816 DUNLAWTON AVE",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321272921",
"telephone_number": "386-322-3919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "JERRY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-10",
"last_updated": "2022-10-10",
"certification_date": "2022-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS33345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.