David Ellery Mathis, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS41750 Issued in FL

Practice address

2094 W US Highway 90
Lake City, FL 32055-4720

Phone

(386) 755-0313

Fax

(386) 755-5994

NPI assigned

Aug 28, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Lake City, FL
  • NPI 1285649459
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1314489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314489600000",
    "number": "1982984456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2094 W US HIGHWAY 90",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320554720",
            "telephone_number": "386-755-0313",
            "fax_number": "386-755-5994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2094 W US HIGHWAY 90",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320554720",
            "telephone_number": "386-755-0313",
            "fax_number": "386-755-5994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "DAVID",
        "middle_name": "ELLERY",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-28",
        "last_updated": "2011-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS41750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Nicole Martino, PHARMD
• Emily E Masten
• Ceili Masterson, DMD
• David Mate, MSW, LCSW
• Darrel Thomas Mathis, D.C.,F.A.C.O.
• Carroll Clayton Matthews
• Jarvis Matthews
• Marilyn Matthews, LCSW
• Scott Michael Mattimore, RN
• Amanda Maxwell

• Pharmacist in Lake City, FL
• Providers in Lake City, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.

Verify at the official NPI Registry.