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1871015016 NPI number — SHANNON BLIZZARD USZTOK PHARMD

NPI Number: 1871015016
Health Care Provider/Practitioner: SHANNON BLIZZARD USZTOK PHARMD

Information about “1871015016” NPI (SHANNON BLIZZARD USZTOK PHARMD) exists in 1871015016 in HTML format HTML  |  1871015016 in plain Text format TXT  |  1871015016 in PDF (Portable Document Format) PDF  |  1871015016 in an XML format XML  formats.

NPI Number : 1871015016 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871015016",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "USZTOK",
    "FirstName": "SHANNON",
    "MiddleName": "BLIZZARD",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BLIZZARD",
    "OtherFirstName": "SHANNON",
    "OtherMiddleName": "SUMNER",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PHARMD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "655 WEST 8TH STREET",
    "SecondLineMailingAddress": "PHARMACY, #83",
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32209",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-244-0354",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "655 WEST 8TH STREET",
    "SecondLinePracticeLocationAddress": "PHARMACY, #83",
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32209",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-244-0354",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/10/2017",
    "LastUpdateDate": "09/20/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "PS56327",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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