Active NPI
Roosevelt Alonzo Blye Jr., PHARM.D
- Pharmacist
- Long Beach, MS
National Provider Identifier
1780974238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 09535
- Practice address
- 200 West Railroad Street Suite B
Rite Aid
Long Beach, MS 39560-2269 - Phone
- (228) 864-0334
- NPI assigned
- Apr 18, 2011
- Last updated
- Apr 18, 2011
- Sex
- Male
- 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 | 09535 | MS | Primary |
Addresses
Primary practice location
200 West Railroad Street Suite B
Rite Aid
Long Beach, MS 39560-2269
Mailing address
1593 Rachel Drive
Biloxi, MS 39532
Phone (228) 392-0112
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
| License | State | Type | Specialty |
|---|---|---|---|
| 09535 | MS | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303084800000",
"number": "1780974238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1593 RACHEL DRIVE",
"city": "BILOXI",
"state": "MS",
"postal_code": "39532",
"telephone_number": "228-392-0112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WEST RAILROAD STREET SUITE B",
"address_2": "RITE AID",
"city": "LONG BEACH",
"state": "MS",
"postal_code": "395602269",
"telephone_number": "228-864-0334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLYE",
"first_name": "ROOSEVELT",
"middle_name": "ALONZO",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-18",
"last_updated": "2011-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "09535",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.