Active NPI
Maged A Khodeir, RPH
- Pharmacist
- Port Saint Lucie, FL
National Provider Identifier
1922619873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS53982
- Practice address
- 2901 SW Port St Lucie Blvd
Port Saint Lucie, FL 34953-3222 - Phone
- (772) 336-3108
- Fax
- (772) 336-8765
- NPI assigned
- Aug 13, 2020
- Last updated
- Dec 22, 2022
- 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 | PS53982 | FL | Primary |
Addresses
Primary practice location
2901 SW Port St Lucie Blvd
Port Saint Lucie, FL 34953-3222
Mailing address
11339 SW Reston CT
Port Saint Lucie, FL 34987-2787
Phone (772) 475-4702
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 |
|---|---|---|---|
| PS53982 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
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": "1597276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1922619873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11339 SW RESTON CT",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349872787",
"telephone_number": "772-475-4702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 SW PORT ST LUCIE BLVD",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349533222",
"telephone_number": "772-336-3108",
"fax_number": "772-336-8765"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHODEIR",
"first_name": "MAGED",
"middle_name": "A",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-13",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS53982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Saint Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.