Active NPI
Alyssa Baclig
- Pharmacist
- Destin, FL
National Provider Identifier
1790407740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 64637
- Practice address
- 977 Highway 98 E
Destin, FL 32541-2801 - Phone
- (850) 650-4538
- NPI assigned
- Sep 15, 2022
- Last updated
- Sep 15, 2022
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 86147 | CA | |
| Pharmacist | 183500000X | 64637 | FL | Primary |
Addresses
Primary practice location
977 Highway 98 E
Destin, FL 32541-2801
Mailing address
200 Page Bacon Rd Apt 4106
Mary Esther, FL 32569-1767
Phone (951) 310-8040
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 |
|---|---|---|---|
| 86147 | CA | MD | Pharmacist |
| 64637 | 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": "1663200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663200000000",
"number": "1790407740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 PAGE BACON RD APT 4106",
"city": "MARY ESTHER",
"state": "FL",
"postal_code": "325691767",
"telephone_number": "951-310-8040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "977 HIGHWAY 98 E",
"city": "DESTIN",
"state": "FL",
"postal_code": "325412801",
"telephone_number": "850-650-4538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACLIG",
"first_name": "ALYSSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-15",
"last_updated": "2022-09-15",
"certification_date": "2022-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "86147",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "64637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Destin, FL
- Anesthesia Inc (Emerald Coast Pain Services)
- Arc Therapy Services LLC (HCA Florida Healthcare at Home)
- Ashley Kay Archer, CCC-SLP
- Jerolyn R Ashcraft, CRNFA
- Rosalind Austin
- Heather Mills Baker, PA
- Bill Gaither Banks, DDS MS
- Samuel Jonathan Barbee, D.C.
- Richard John Barnett, M.D.
- Charles B Barniv, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.