NPIMap

Organization Active NPI

Dallas Express Pharmacy

  • Community/Retail Pharmacy
  • Dallas, NC
National Provider Identifier
1003172792
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
09048 Issued in NC
Legal business name
DALLAS EXPRESS PHARMACY
Practice address
111A N Hoffman St
Dallas, NC 28034-1597
Phone
(704) 922-3001
Fax
(704) 922-0060
NPI assigned
Apr 6, 2012
Last updated
Sep 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Authorized official

Name
Mr. Jacob Tyler Wallace Jr.
Title
President
Phone
(704) 922-3001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 09048 NC Primary

Addresses

Primary practice location

111A N Hoffman St
Dallas, NC 28034-1597

Mailing address

111A N Hoffman St
Dallas, NC 28034-1597
Phone (704) 922-3001

Other identifiers 2

IdentifierTypeStateIssuer
3403451OtherNCNCPDP
0366203MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Dallas Express Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1333670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1003172792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111A N HOFFMAN ST",
            "city": "DALLAS",
            "state": "NC",
            "postal_code": "280341597",
            "telephone_number": "704-922-3001",
            "fax_number": "704-922-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111A N HOFFMAN ST",
            "city": "DALLAS",
            "state": "NC",
            "postal_code": "280341597",
            "telephone_number": "704-922-3001",
            "fax_number": "704-922-0060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS EXPRESS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-06",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-922-3001",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "09048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3403451",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0366203",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; 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.