Individual provider Active NPI

Mallory Demott, RPH

  • Pharmacist
  • Tallahassee, FL
National Provider Identifier
1639623721
Registry record updated Jul 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS55030 Issued in FL
Practice address
6615 Mahan Dr
Tallahassee, FL 32308-1400
Phone
(850) 878-5559
NPI assigned
Aug 7, 2016
Sex
Female
Sole proprietor
No

Organizations & group practices 3

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.

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

LicenseStateTypeSpecialty
PS55030FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Publix Super Markets Inc Past Accepting new patients
Publix Super Markets Inc PastSince Jul 23, 2023 Accepting new patients
Publix Super Markets Inc PastSince Jul 23, 2023 Accepting new patients

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS55030 FL Primary

Addresses

NPPES NPI Registry

Primary practice location

6615 Mahan Dr
Tallahassee, FL 32308-1400

Mailing address

13775 US Highway 19 S
Thomasville, GA 31792-5398
Phone (229) 228-6419

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 22, 2023.

{
    "created_epoch": "1470528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689984000000",
    "number": "1639623721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13775 US HIGHWAY 19 S",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925398",
            "telephone_number": "229-228-6419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 MAHAN DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323081400",
            "telephone_number": "850-878-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMOTT",
        "first_name": "MALLORY",
        "name_prefix": "Ms.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-07",
        "last_updated": "2023-07-22",
        "certification_date": "2023-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS55030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.

Verify at the official NPI Registry.