Active NPI
Jerrin Samuel
- Pharmacist
- Wellington, FL
National Provider Identifier
1710583380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS61791
- Practice address
- 9181 Dupont PL
Wellington, FL 33414-6475 - Phone
- (561) 603-1043
- NPI assigned
- Dec 9, 2020
- Sex
- Female
- 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 | PS61791 | FL | Primary |
Addresses
Primary practice location
9181 Dupont PL
Wellington, FL 33414-6475
Mailing address
9181 Dupont PL
Wellington, FL 33414-6475
Phone (561) 603-1043
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 |
|---|---|---|---|
| PS61791 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628121600000",
"number": "1710583380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9181 DUPONT PL",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "334146475",
"telephone_number": "561-603-1043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9181 DUPONT PL",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "334146475",
"telephone_number": "561-603-1043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "JERRIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-09",
"last_updated": "2021-08-05",
"certification_date": "2021-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS61791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wellington, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.