Active NPI
Jennifer Dianne Pickens
- Pharmacist
- Casselberry, FL
National Provider Identifier
1639416407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS37861
- Practice address
- 1455 State Road 436 Ste 221
Casselberry, FL 32707-6514 - Phone
- (407) 673-0788
- Fax
- (407) 673-0987
- NPI assigned
- Jan 13, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS37861 | FL | Primary |
| Pharmacist | 183500000X | RPH020846 | GA |
Addresses
Primary practice location
1455 State Road 436 Ste 221
Casselberry, FL 32707-6514
Mailing address
1455 State Road 436 Ste 221
Casselberry, FL 32707-6514
Phone (407) 673-0788
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 |
|---|---|---|---|
| PS37861 | FL | MD | Pharmacist |
| RPH020846 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Publix Super Markets Inc | Past | Accepting new patients | |
| Publix Super Markets Inc | 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
- Casselberry, FL
- NPI 1013233402
-
- Community/Retail Pharmacy
- Winter Haven, FL
- NPI 1760356380
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358035200000",
"number": "1639416407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1455 STATE ROAD 436 STE 221",
"city": "CASSELBERRY",
"state": "FL",
"postal_code": "327076514",
"telephone_number": "407-673-0788",
"fax_number": "407-673-0987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1455 STATE ROAD 436 STE 221",
"city": "CASSELBERRY",
"state": "FL",
"postal_code": "327076514",
"telephone_number": "407-673-0788",
"fax_number": "407-673-0987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKENS",
"first_name": "JENNIFER",
"middle_name": "DIANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-13",
"last_updated": "2013-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS37861",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH020846",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Casselberry, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.