Active NPI
Kathy M Clark
- Pharmacist
- North Port, FL
National Provider Identifier
1861762361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS23050
- Practice address
- 1063 N Toledo Blade Blvd
North Port, FL 34288-2400 - Phone
- (941) 429-6174
- Fax
- (941) 429-8517
- NPI assigned
- Dec 31, 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 | PS23050 | FL | Primary |
Addresses
Primary practice location
1063 N Toledo Blade Blvd
North Port, FL 34288-2400
Mailing address
1063 N Toledo Blade Blvd
North Port, FL 34288-2400
Phone (941) 429-6174
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 |
|---|---|---|---|
| PS23050 | 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": "1325289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325289600000",
"number": "1861762361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1063 N TOLEDO BLADE BLVD",
"city": "NORTH PORT",
"state": "FL",
"postal_code": "342882400",
"telephone_number": "941-429-6174",
"fax_number": "941-429-8517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1063 N TOLEDO BLADE BLVD",
"city": "NORTH PORT",
"state": "FL",
"postal_code": "342882400",
"telephone_number": "941-429-6174",
"fax_number": "941-429-8517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KATHY",
"middle_name": "M",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-31",
"last_updated": "2011-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS23050",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Port, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.