Active NPI
Bryan Henderson
- Pharmacist
- Pace, FL
National Provider Identifier
1699465559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS29768
- Practice address
- 4854 Woodbine Rd Unit 5
Pace, FL 32571-8709 - Phone
- (850) 463-0022
- Fax
- (850) 994-7979
- NPI assigned
- May 12, 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 | PS29768 | FL | Primary |
Addresses
Primary practice location
4854 Woodbine Rd Unit 5
Pace, FL 32571-8709
Mailing address
4854 Woodbine Rd Unit 5
Pace, FL 32571-8709
Phone (850) 463-0022
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 |
|---|---|---|---|
| PS29768 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683849600000",
"number": "1699465559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4854 WOODBINE RD UNIT 5",
"city": "PACE",
"state": "FL",
"postal_code": "325718709",
"telephone_number": "850-463-0022",
"fax_number": "850-994-7979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4854 WOODBINE RD UNIT 5",
"city": "PACE",
"state": "FL",
"postal_code": "325718709",
"telephone_number": "850-463-0022",
"fax_number": "850-994-7979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "BRYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-12",
"last_updated": "2023-05-12",
"certification_date": "2023-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS29768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pace, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.