Active NPI
Nicholas Thomas Brudnak III, RPH
- Pharmacist
- Davenport, FL
National Provider Identifier
1922377290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS34682
- Practice address
- 45549 Highway 27
Davenport, FL 33897-4519 - Phone
- (863) 420-6120
- Fax
- (863) 420-6112
- NPI assigned
- Dec 15, 2011
- Last updated
- Dec 15, 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 | PS34682 | FL | Primary |
Addresses
Primary practice location
45549 Highway 27
Davenport, FL 33897-4519
Mailing address
45549 Highway 27
Davenport, FL 33897-4519
Phone (863) 420-6120
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS34682 | 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": "1323907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323907200000",
"number": "1922377290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45549 HIGHWAY 27",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338974519",
"telephone_number": "863-420-6120",
"fax_number": "863-420-6112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45549 HIGHWAY 27",
"city": "DAVENPORT",
"state": "FL",
"postal_code": "338974519",
"telephone_number": "863-420-6120",
"fax_number": "863-420-6112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUDNAK",
"first_name": "NICHOLAS",
"middle_name": "THOMAS",
"name_suffix": "III",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-12-15",
"last_updated": "2011-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS34682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davenport, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.