Individual provider Active NPI

Emily Peace Heruska, PHARMD

  • Pharmacist
  • Valdosta, GA
National Provider Identifier
1780970475
Registry record updated Jun 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH022121 Issued in GA
Practice address
212 Northside Dr
Valdosta, GA 31602-1858
Phone
(229) 242-3060
Fax
(229) 316-1366
NPI assigned
Jun 22, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH022121 GA Primary

Addresses

Primary practice location

212 Northside Dr
Valdosta, GA 31602-1858

Mailing address

212 Northside Dr
Valdosta, GA 31602-1858
Phone (229) 242-3060

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
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
RPH022121GAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308700800000",
    "number": "1780970475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 NORTHSIDE DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021858",
            "telephone_number": "229-242-3060",
            "fax_number": "229-316-1366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 NORTHSIDE DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316021858",
            "telephone_number": "229-242-3060",
            "fax_number": "229-316-1366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERUSKA",
        "first_name": "EMILY",
        "middle_name": "PEACE",
        "name_prefix": "Mrs.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH022121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.

Verify at the official NPI Registry.