Active NPI
Cathy Broome, PHARMACIST
- Pharmacist
- Gulfport, MS
National Provider Identifier
1740564319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-7189
- Practice address
- 15371 Dedeaux Rd
Gulfport, MS 39503-3123 - Phone
- (228) 539-9890
- Fax
- (228) 539-0238
- NPI assigned
- Sep 30, 2011
- Last updated
- Sep 30, 2011
- Sex
- Female
- 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 | E-7189 | MS | Primary |
Addresses
Primary practice location
15371 Dedeaux Rd
Gulfport, MS 39503-3123
Mailing address
15371 Dedeaux Rd
Gulfport, MS 39503-3123
Phone (228) 539-9890
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00330509 | Medicaid | MS |
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 |
|---|---|---|---|
| E-7189 | MS | 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": "1317340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317340800000",
"number": "1740564319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15371 DEDEAUX RD",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395033123",
"telephone_number": "228-539-9890",
"fax_number": "228-539-0238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15371 DEDEAUX RD",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395033123",
"telephone_number": "228-539-9890",
"fax_number": "228-539-0238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOME",
"first_name": "CATHY",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-30",
"last_updated": "2011-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-7189",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00330509",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.