Active NPI
Grant Defalque, PHARMD
- Pharmacist
- Lakeland, FL
National Provider Identifier
1679359293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS66309
- Practice address
- 5185 US Highway 98 South
Lakeland, FL 33812 - Phone
- (864) 644-7969
- NPI assigned
- Sep 8, 2023
- 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 | PS66309 | FL | Primary |
Addresses
Primary practice location
5185 US Highway 98 South
Lakeland, FL 33812
Mailing address
1533 Village Center Dr
Lakeland, FL 33803-2858
Phone (317) 847-1368
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS66309 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694131200000",
"number": "1679359293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1533 VILLAGE CENTER DR",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338032858",
"telephone_number": "317-847-1368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5185 US HIGHWAY 98 SOUTH",
"city": "LAKELAND",
"state": "FL",
"postal_code": "33812",
"telephone_number": "864-644-7969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFALQUE",
"first_name": "GRANT",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-08",
"last_updated": "2023-09-08",
"certification_date": "2023-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS66309",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.