Active NPI
Brian Ward Nelson, RPH
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Fort Myers, FL
National Provider Identifier
1730474206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- PS0015183
- Practice address
- 9350 Dynasty Dr
Target 2369
Fort Myers, FL 33905-5574 - Phone
- (239) 265-9023
- Fax
- (239) 265-9033
- NPI assigned
- Jun 13, 2011
- Last updated
- Jun 13, 2011
- 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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | PS0015183 | FL | Primary |
Addresses
Primary practice location
9350 Dynasty Dr
Target 2369
Fort Myers, FL 33905-5574
Mailing address
9350 Dynasty Dr
Target 2369
Fort Myers, FL 33905-5574
Phone (239) 265-9023
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 |
|---|---|---|---|
| PS0015183 | FL | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Carolina CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
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": "1307923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307923200000",
"number": "1730474206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9350 DYNASTY DR",
"address_2": "TARGET 2369",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339055574",
"telephone_number": "239-265-9023",
"fax_number": "239-265-9033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9350 DYNASTY DR",
"address_2": "TARGET 2369",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339055574",
"telephone_number": "239-265-9023",
"fax_number": "239-265-9033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "BRIAN",
"middle_name": "WARD",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-13",
"last_updated": "2011-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "FL",
"license": "PS0015183",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.