Active NPI
Santander Bornacelly, B652758014569
- Pharmacist
- Hagerstown, MD
National Provider Identifier
1699189118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13789
- Practice address
- 580 Wesel Blvd
Hagerstown, MD 21740 - Phone
- (301) 739-7230
- Fax
- (301) 733-1558
- NPI assigned
- Jun 12, 2014
- 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 | 13789 | MD | Primary |
Addresses
Primary practice location
580 Wesel Blvd
Hagerstown, MD 21740
Mailing address
13405 John Martin Dr
Williamsport, MD 21795-1605
Phone (301) 739-7230
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 |
|---|---|---|---|
| 13789 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402531200000",
"number": "1699189118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13405 JOHN MARTIN DR",
"city": "WILLIAMSPORT",
"state": "MD",
"postal_code": "217951605",
"telephone_number": "301-739-7230",
"fax_number": "301-733-1558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 WESEL BLVD",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "21740",
"telephone_number": "301-739-7230",
"fax_number": "301-733-1558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORNACELLY",
"first_name": "SANTANDER",
"credential": "B652758014569",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-12",
"last_updated": "2014-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "13789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hagerstown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.