Active NPI
Eric Revak
- Pharmacist
- Lehigh Acres, FL
National Provider Identifier
1669719613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS48295
- Practice address
- 5781 Lee Blvd
Lehigh Acres, FL 33971-6337 - Phone
- (239) 226-9707
- NPI assigned
- Jan 10, 2013
- 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 | PS48295 | FL | Primary |
Addresses
Primary practice location
5781 Lee Blvd
Lehigh Acres, FL 33971-6337
Mailing address
3000 Oasis Grand Blvd
Apt 1804
Fort Myers, FL 33916-1524
Phone (239) 226-9707
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 |
|---|---|---|---|
| PS48295 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1357776000000",
"number": "1669719613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3000 OASIS GRAND BLVD",
"address_2": "APT 1804",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339161524",
"telephone_number": "239-226-9707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5781 LEE BLVD",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339716337",
"telephone_number": "239-226-9707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVAK",
"first_name": "ERIC",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-10",
"last_updated": "2013-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS48295",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lehigh Acres, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 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.