Active NPI
Cromartie Nickerson, PHARMD
- Pharmacist
- Jacksonville, FL
National Provider Identifier
1982048559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS49456
- Practice address
- 7546 103Rd St
Jacksonville, FL 32210-6713 - Phone
- (904) 777-3050
- NPI assigned
- Apr 25, 2013
- Last updated
- Apr 25, 2013
- 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 | PS49456 | FL | Primary |
Addresses
Primary practice location
7546 103Rd St
Jacksonville, FL 32210-6713
Mailing address
3505 University Blvd W
Jacksonville, FL 32217-2130
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS49456 | 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": "1366848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366848000000",
"number": "1982048559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3505 UNIVERSITY BLVD W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322172130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7546 103RD ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322106713",
"telephone_number": "904-777-3050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "CROMARTIE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-25",
"last_updated": "2013-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS49456",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.