Active NPI
Katherine Colvin Petsos, BPHARM
- Pharmacist
- Merritt Island, FL
National Provider Identifier
1750680518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS17454
- Practice address
- 90 S Sykes Creek Pkwy
Merritt Island, FL 32952-3593 - Phone
- (321) 452-5612
- Fax
- (321) 459-2642
- NPI assigned
- Mar 19, 2011
- Last updated
- Mar 19, 2011
- 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 | PS17454 | FL | Primary |
Addresses
Primary practice location
90 S Sykes Creek Pkwy
Merritt Island, FL 32952-3593
Mailing address
90 S Sykes Creek Pkwy
Merritt Island, FL 32952-3593
Phone (321) 452-5612
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 |
|---|---|---|---|
| PS17454 | 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": "1300492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300492800000",
"number": "1750680518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 S SYKES CREEK PKWY",
"city": "MERRITT ISLAND",
"state": "FL",
"postal_code": "329523593",
"telephone_number": "321-452-5612",
"fax_number": "321-459-2642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 S SYKES CREEK PKWY",
"city": "MERRITT ISLAND",
"state": "FL",
"postal_code": "329523593",
"telephone_number": "321-452-5612",
"fax_number": "321-459-2642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETSOS",
"first_name": "KATHERINE",
"middle_name": "COLVIN",
"name_prefix": "Mrs.",
"credential": "BPHARM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-19",
"last_updated": "2011-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS17454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merritt Island, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.