NPIMap

Individual provider Active NPI

Kim Michelle Pearson

  • Pharmacist
  • Lutz, FL
National Provider Identifier
1861778243
Registry record updated Oct 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS0034213 Issued in FL
Practice address
3890 Van Dyke Rd
Lutz, FL 33548-4800
Phone
(813) 269-2814
Fax
(813) 265-4317
NPI assigned
Oct 29, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 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 PS0034213 FL Primary

Addresses

Primary practice location

3890 Van Dyke Rd
Lutz, FL 33548-4800

Mailing address

3890 Van Dyke Rd
Lutz, FL 33548-4800
Phone (813) 269-2814

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

LicenseStateTypeSpecialty
PS0034213FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1319846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319846400000",
    "number": "1861778243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3890 VAN DYKE RD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484800",
            "telephone_number": "813-269-2814",
            "fax_number": "813-265-4317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3890 VAN DYKE RD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335484800",
            "telephone_number": "813-269-2814",
            "fax_number": "813-265-4317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "KIM",
        "middle_name": "MICHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-29",
        "last_updated": "2011-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS0034213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.