Active NPI
Kenneth E Good, RPH
- Pharmacist
- St Augustine, FL
National Provider Identifier
1649604182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS17333
- Practice address
- 101 S Ponce de Leon Blvd
St Augustine, FL 32084-4213 - Phone
- (904) 825-2181
- NPI assigned
- Aug 31, 2013
- 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 | PS17333 | FL | Primary |
Addresses
Primary practice location
101 S Ponce de Leon Blvd
St Augustine, FL 32084-4213
Mailing address
101 S Ponce de Leon Blvd
St Augustine, FL 32084-4213
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
| License | State | Type | Specialty |
|---|---|---|---|
| PS17333 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377907200000",
"number": "1649604182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 S PONCE DE LEON BLVD",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320844213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 S PONCE DE LEON BLVD",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320844213",
"telephone_number": "904-825-2181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOOD",
"first_name": "KENNETH",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-31",
"last_updated": "2013-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS17333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.