Active NPI
Ellwood Herbert Stoddard, RPH
- Pharmacist
- Cocoa Beach, FL
National Provider Identifier
1659633600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS0012737
- Practice address
- 100 Canaveral Plaza Blvd
Cocoa Beach, FL 32931-3520 - Phone
- (321) 868-2287
- Fax
- (321) 784-8768
- NPI assigned
- Jun 14, 2012
- Sex
- Male
- 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 | PS0012737 | FL | Primary |
Addresses
Primary practice location
100 Canaveral Plaza Blvd
Cocoa Beach, FL 32931-3520
Mailing address
100 Canaveral Plaza Blvd
Cocoa Beach, FL 32931-3520
Phone (321) 868-2287
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 |
|---|---|---|---|
| PS0012737 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339632000000",
"number": "1659633600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 CANAVERAL PLAZA BLVD",
"city": "COCOA BEACH",
"state": "FL",
"postal_code": "329313520",
"telephone_number": "321-868-2287",
"fax_number": "321-784-8768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CANAVERAL PLAZA BLVD",
"city": "COCOA BEACH",
"state": "FL",
"postal_code": "329313520",
"telephone_number": "321-868-2287",
"fax_number": "321-784-8768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STODDARD",
"first_name": "ELLWOOD",
"middle_name": "HERBERT",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-14",
"last_updated": "2012-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS0012737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cocoa Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.