Active NPI
John Nicholas Fedorovich, R.PH.
- Pharmacist
- Holly Hill, FL
National Provider Identifier
1730469297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS15388
- Practice address
- 1829 Ridgewood Ave
Holly Hill, FL 32117-1737 - Phone
- (386) 672-6388
- Fax
- (386) 672-0495
- NPI assigned
- Aug 27, 2011
- Last updated
- Aug 27, 2011
- 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 | PS15388 | FL | Primary |
Addresses
Primary practice location
1829 Ridgewood Ave
Holly Hill, FL 32117-1737
Mailing address
1829 Ridgewood Ave
Holly Hill, FL 32117-1737
Phone (386) 672-6388
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS15388 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314403200000",
"number": "1730469297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1829 RIDGEWOOD AVE",
"city": "HOLLY HILL",
"state": "FL",
"postal_code": "321171737",
"telephone_number": "386-672-6388",
"fax_number": "386-672-0495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1829 RIDGEWOOD AVE",
"city": "HOLLY HILL",
"state": "FL",
"postal_code": "321171737",
"telephone_number": "386-672-6388",
"fax_number": "386-672-0495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEDOROVICH",
"first_name": "JOHN",
"middle_name": "NICHOLAS",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-27",
"last_updated": "2011-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS15388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holly Hill, FL
- Elderly Living Center of Holly Hill, Inc
- Emergency Medical Foundation Inc (EVAC Ambulance)
- Lambert Harold Everson, CNA
- Faithful Caregivers,LLC
- Family Medical Practice Management, Inc.
- Christina Fendelander, RPH
- Cynthia Stephens Fisher, MSW
- Five Star Rehabilitation and Wellness Services, LLC. (Ageility Physical Therapy Solutions at Riviera)
- Florehab, Inc.
- Florida Health Care Plan Inc (Florida Health Care Plans Pharmacy Mail)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.