Active NPI
Jenny Carolina Chavez Reyes
- Pharmacist
- Crestview, FL
National Provider Identifier
1740881614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS43804
- Practice address
- 3351 S Ferdon Blvd
Crestview, FL 32536-8484 - Phone
- (850) 682-9107
- NPI assigned
- Nov 5, 2020
- Last updated
- Nov 14, 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 | PS43804 | FL | Primary |
Addresses
Primary practice location
3351 S Ferdon Blvd
Crestview, FL 32536-8484
Mailing address
439 Hatchee Dr
Crestview, FL 32536-5203
Phone (850) 603-9107
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 |
|---|---|---|---|
| PS43804 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past | Accepting new patients | |
| Wal-Mart Stores East, LP | 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.
-
dba Walmart Pharmacy 10-0944
- Community/Retail Pharmacy
- Crestview, FL
- NPI 1134146343
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605312000000",
"number": "1740881614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "439 HATCHEE DR",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325365203",
"telephone_number": "850-603-9107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3351 S FERDON BLVD",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325368484",
"telephone_number": "850-682-9107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAVEZ REYES",
"first_name": "JENNY",
"middle_name": "CAROLINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-05",
"last_updated": "2020-11-14",
"certification_date": "2020-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS43804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crestview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.