Active NPI
Roger Dale Houston
- Pharmacist
- Lithia, FL
National Provider Identifier
1962782201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 21830
- Practice address
- 6112 Gannetwoord Place
Lithia, FL 33547 - Phone
- (813) 385-0155
- NPI assigned
- Aug 18, 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 | 21830 | MI | Primary |
Addresses
Primary practice location
6112 Gannetwoord Place
Lithia, FL 33547
Mailing address
6112 Gannetwoord Place
Lithia, FL 33547
Phone (813) 385-0155
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21830 | Other | MI | PHARMACY LICENSE NUMBER |
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 |
|---|---|---|---|
| 21830 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313625600000",
"number": "1962782201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6112 GANNETWOORD PLACE",
"city": "LITHIA",
"state": "FL",
"postal_code": "33547",
"telephone_number": "813-385-0155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6112 GANNETWOORD PLACE",
"city": "LITHIA",
"state": "FL",
"postal_code": "33547",
"telephone_number": "813-385-0155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOUSTON",
"first_name": "ROGER",
"middle_name": "DALE",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-18",
"last_updated": "2011-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "21830",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE NUMBER",
"identifier": "21830",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lithia, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.