Prescription Place of Niceville LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH28801 Issued in FL

Legal business name

PRESCRIPTION PLACE OF NICEVILLE LLC

Practice address

1140 John Sims Pkwy E
Suite 6
Niceville, FL 32578-2204

Phone

(850) 389-8182

Fax

(850) 389-8185

NPI assigned

Jan 14, 2015

Last updated

Feb 5, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shane G AbbottNPI 1144336348

Title

Owner

Phone

(850) 389-8182

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Tax ID family

Prescription Place of Niceville LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prescription Place of Niceville LLC

  • Long Term Care Pharmacy
  • Niceville, FL
  • NPI 1699632620
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Prescription Place of Defuniak Springs Inc

  dba The Prescription Place

  • Community/Retail Pharmacy
  • Defuniak Springs, FL
  • NPI 1457370520

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shane G Abbott, RPH

  • Pharmacist
  • Defuniak Springs, FL
  • NPI 1144336348
  Authorized official Same address or phone

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

{
    "created_epoch": "1421193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549324800000",
    "number": "1891184859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 JOHN SIMS PKWY E",
            "address_2": "SUITE 6",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325782204",
            "telephone_number": "850-892-6898",
            "fax_number": "850-389-8182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 JOHN SIMS PKWY E",
            "address_2": "SUITE 6",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325782204",
            "telephone_number": "850-389-8182",
            "fax_number": "850-389-8185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESCRIPTION PLACE OF NICEVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-14",
        "last_updated": "2019-02-05",
        "status": "A",
        "authorized_official_last_name": "ABBOTT",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-389-8182"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH28801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA STATE LICENSE",
            "identifier": "PH28801",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014786600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Faith Portz
• Brandie L Postrero, APRN, FNP-C
• Leigh Gayle Powers, DNP
• Jennifer Leah Pratt, LMT
• Prescription Place of Niceville LLC
• April R Pretz, APRN
• Daina Price
• Pro Active Chiropractic Group Inc
• Pro-Active Medical Center, LLC
• Psychconcepts, Inc

• Community/Retail Pharmacy in Niceville, FL
• Providers in Niceville, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.